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9180 Electrolyte Analyzer Operator`s Manual

1. 6 15 Remove used electrode 64 Install the new pump winding plate and slip the new pump windings over the analyzer pump rollers being careful not to cross the tubes Press NO until CALIBRATION is displayed Press YES to initiate a calibration cycle Unscheduled Maintenance Changing electrodes Slide the measuring chamber forward until 1t locks in the front position See illustration 6 13 Unclamp the left electrode holder by moving the clamp forward See illustration 6 14 Remove the used electrode from the measuring chamber See illustration 6 15 6 18 Closing electrode clamp Remove the new electrode from its protective box and check for the presence of an o ring 1n the left side of the electrode See illustration 6 16 Install electrode in its labeled position in the measur ing chamber Note that the electrode has a lip on the bottom that rests on the flat edge of the measuring chamber to aid in proper positioning See illustration 6 17 Close the clamp on the left electrode holder by lifting it upward until it locks in the back position Ensure that the electrodes are seated properly See illustration 6 18 65 6 19 Slide measuring chamber back f me e Aa E N EN P 6 20 Removal of used ISE SnapPak 66 Slide the measuring chamber back until it snaps into position See illustration 6 19
2. Warning Changes or modifications to this unit not expressly approved by the party responsible for compliance could void the user s authority to operate the equipment Note This equipment has been tested and found to comply with the limits for a Class B digital device pursuant to Part 15 of the FCC Rules These limits are designed to provide reasonable protection against harmful interference in a residential installation This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to radio commu nication However there is no guarantee that interference will not occur in a particular installation If this equipment does not cause harmful interference to radio or television reception which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures Reorient or relocate the receiving antenna Increase the separation between the equipment and receiver e Connect the equipment into an outlet on a circuit different from that to which the receiver is connected Consult the dealer or an experienced radio TV technician for help Caution e The instrument is designed as a conventional device closed not waterproof type Do not operate the instrument in an explosive environment or in the vicinity of
3. PM eastern time Our Order Entry representative will gladly provide any assistance you may require Electrodes Potassium Electrode Sodium Electrode Chloride Electrode Calcium Electrode Lithium Electrode Reference Electrode Reference Housing with Tubing Assembly Solutions ISE SnapPak 9180 Cleaning Solution A Electrode Conditioning Solution Urine Diluent ISE trol Quality Control Kit Tri level 36 x 1mL BP0359 BP0413 BP0570 BP0360 BP0962 BP5026 BP5019 BP5186 BP1025 BP0380 BP0344 HC0033 111 112 Supplies Printer Paper 5 rolls Pump Tubing Set Complete Valve Tubing Set Interconnectors Spare Parts Sample Probe with Tubing Reference Solution Interconnector Fill Port Tubing with red tag Fill Port Complete Reference Electrode O ring Electrode Interconnect O ring Quad Ring Fuse 0 3 amp slow blow Fuse 1 25 amp slow blow Fuse 1 6 amp slow blow Fuse 2 0 amp slow blow Reference Electrode Transport Housing for storage Service Syringe 12 mL Printer Paper Tray Reference Solution Double Tubing Solenoid Relief Clamp Stylet for Cleaning Sample Probe Operators Manual for 9180 English Operators Manual for 9180 International Service Manual for 9180 Shut Down Kit Interface Kit 9180 to Compact 2 Technical Assistance BP5025 BP5027 BP5193 BP5006 BP5020 BP5029 BP9043 DAO0111 DA0156 EV5000 EV0082 EV0044 EV0045 HV0294 MCO0007 RE5016 SS
4. as well as cleaning and maintenance information The unit is configured to allow conve nient storage of a second roll of paper in the paper tray See illustration 1 11 The model and serial number is located on an identifi cation plate above the probe mechanism See illustration 1 12 The rear panel of the unit contains a serial number plate as well as the power switch power receptacle module and an RS232 interface port See illustration 1 13 Congratulations You ve just learned the basic components of the analyzer and are now ready to install your system 10 i 2 1 Space requirements Chapter 2 Installation Choosing a location for the AVL Electrolyte Analyzer Location is important for trouble free operation of your analyzer Before you begin setup choose a site that is convenient for your sampling needs and meets the following physical requirements of the unit e Grounded electrical outlet e Away from direct sunlight e Room temperature between 15 C and 32 C 60 F and 90 F Maximum relative humidity of 85 e Ample room to allow air to circulate freely around the unit See illustration 2 1 e Away from strong electromagnetic fields such as those created by electric motors and x ray equipment e Away from explosive gases or vapors 13 14 Now it s time to unpack your AVL Electrolyte Ana lyzer Carefully remove the unit from the box DO NOT lift the analyzer
5. As demonstrated by these equations the ion selective electrodes do not measure the ion concentration but the activity of the 10ns concerned This activity 1s a criterion of the ion s ability to interact with other 10ns in which each ion binds a proportion of its energy The ion concentration is calculated on the basis of the ion activity The correlation is affected by the total number of ions n the solution Because sodium in whole blood and serum is the predominant ion the known value of the sodium concentration makes it possible to ascertain and adjust for total ion effect and strength di voltmeter B reference electrode Inner solution ion selective electrode any ion selective membrane measured solution 00 C a 8 1 Measurement principle f amplifier display aa a Mot electrode Na reference housing electrode D al solution A electrode i N Em a electrode ral GI dis electrode capilar inner electrode inner electrolyte SH sample Es chloride selective sodium selective potassium selective membrane membrane membrane y y 8 2 Measurement system 101 Sodium Electrode Specifications The Sodium Electrode is a glass capillary electrode used for in vitro diagnos tic measurement of sodium ions present in fluid samples It is designated with a Na marking on the top surface of the housing Construction Electrode housing transparent acrylic
6. After installing a new electrode the AVL Electrolyte Analyzer needs to undergo Daily Maintenance Cali bration and QC Measurement to verify the performance of the electrode Operator Functions Checking reagent fluid level and changing the ISE SnapPak The AVL Electrolyte Analyzer monitors the level of solutions in the ISE SnapPak and displays the amount remaining To check the status of fluid remaining in the pack 1 Press NO until the prompt OPERATOR FUNCTIONS is displayed Press YES 2 The prompt Change SnapPak will be displayed 3 Press YES The analyzer will display the amount offluid remaining 4 To change the ISE SnapPak it is not neces sary to go to a special menu just grasp the extended portion of the pack and slide it out If removal is difficult press on the end of the ISE SnapPak guide pin protruding from the connector located to the left of the measuring chamber inside the front door See illustration 6 20 6 21 Installing ISE SnapPak As soon as the analyzer detects that the pack has been removed the display prompts Status No SnapPak In addition the printer will print the current status of the ISE SnapPak Note Do not remove the pack during a calibration or measurement procedure Note The ISE SnapPak must be treated as medical waste and disposed of in accordance with local regulations 5 Prepare the new ISE SnapPak by carefully removing the prote
7. Mesna veso Mensa Mesos Beau o7 3um1 2 3 mE sum 1 2 3 p i 3 High Level reference device High Level AVL Wa Wem Mesh I emma Mai Mesos Bear EN NN sum 1 2 3 sum 1 2 3 2o 3 es EA MERE AVE 118 119 120 AVL 9180 Electrolyte Analyzer Operator s Manual Written by Gerri Priest Barbara Smith and Bernie Heitz of AVL Edited by Randy Byrd Tom McNulty and Steve Wickiser Designed illustrated and produced by Rick Burns and Drew Meincke
8. Press NO if you wish to retain all data Then the analyzer will prompt Shutdown Complete Turn Power Off After the power has been turned off unplug the power cord from the receptacle and close the main door Clean all external surfaces of the analyzer as well as the areas accessible through the main door and the sample door For putting the analyzer back nto operation see Chapter 2 Changing printer paper The thermal printer paper supplied by AVL contains an indicator strip to alert you when the paper roll should be changed To change the roll 1 Open the front cover of the analyzer 2 Press the paper feed button to eject any remaining paper 3 Place a new roll in the chamber and thread 1t into the feeder 4 Press the paper feed button to bring the paper completely through the feeder See illustration 6 28 and 6 29 Note By pressing and releasing the paper feed button the paper will automatically advance 10 lines 5 Close the front cover of the analyzer and tear off any excess paper 6 Cut the end of the roll to make a square edge Note Do not pull paper backwards Chapter 7 Troubleshooting and service functions Your AVL Electrolyte Analyzer is designed to pro vide long trouble free service However any scientific measuring device may occasionally malfunc tion requiring the operator to identify the cause of the problem The following information lists displayed messages and recommends ste
9. especially in the sample probe the tubing to the sample sensor and in the sample sensor e Ensure that the sample sensor is securely plugged in and perform a sample sensor test to ensure the sensor is operating correctly If necessary clean the sample sensor e Replace reference electrode housing BPM VS In case the unit displays arrows up or arrows down instead of the sample results the concentration of the sample is outside of the measurement range see specifications Possible remedies e Inthe case of a urine sample arrows up instead of the K result indicate that further dilution of the sample is necessary see Urine Sample e Check for proper sample preparation see Chapter 5 e Check for small air bubbles in the sample after aspiration into the sample chamber e Check for proper aspiration of Standard A T Y With Ca activated the calibration report will print an arrow up or down instead of the actual temperature if the tempera ture measured is out of range Range 10 0 C 40 C The temperature sensor 1s located in the right side electrode holder Possible remedies e Ensure the sample sensor cable is securely plugged in e Make sure room temperature is within specified limits 15 C to 32 C 60 F to 90 F e Perform TEST AMPLIFIER see Service Functions to measure the actual temperature With the front door opened the temperature displayed should be approx 5 C above the actual room temperature 8
10. sample The membrane is an ion exchanger reacting to the electrical change of the ion causing a change in the membrane potential or measuring voltage which is built up in the film between the sample and the membrane A galvanic measuring chain within the electrode determines the difference between the two potential values on either side of the membrane The galvanic 97 98 chain 1s closed through the sample on one side by the reference electrode the reference electrolyte and the open terminal The membrane inner electrolyte and inner electrode close the other side See illustration 8 1 The different ion concentrations between the inner electrolyte and the sample causes an electro chemical potential to form on the membrane of the active electrode The potential is conducted by the inner electrode to the input of an amplifier The reference electrode is connected to ground as well as the second input of the amplifier Since the reference electrode 1s on ground amplifica tion of the electrode potential allows further signal processing The ion concentration in the sample is then determined and displayed by using a calibration curve determined by two measured points of standard solutions with precisely known ion concentrations two point cali bration and by using the measured voltage of the sample and the Standard A one point calibration Physical principle An ion selective electrode 1s connected wi
11. ALWAYS reports direct ISE values and is not affected by correlation factors or the setting of OCC see Service Codes Dialysate Samples Either acetate or bicarbonate dialysate fluids may be analyzed Dialysate samples can be stored longer than whole blood though preferably capped and placed in the refrigerator Prior to measurement always bring the sample to room temperature Note If lithium is activated the dialysate mode is not available Running a sample with the AVL Electrolyte Analyzer The AVL Electrolyte Analyzer provides fast easy operation Whenever READY appears on the dis play the unit is prepared to conduct sampling measurements To analyze a Standard Sample press NO to get to QC STD DIALYSATE URINE SAMPLE Press YES Then press NO until the prompt Standard Sample appears Press YES Note Urine samples require dilution and must be analyzed in the urine mode Instructions for analyz ing urine samples are provided later in this chapter 91 5 N 9 1 Introducing a sample a M 5 2 Cleaning probe a AVLOIBO ELECTROLYTE ISE NA K LI O1MAR96 0720 Sample SERUM Sample No 4 Na 190 T mmol L K 52 mmol L Li mmol L i calculation not possible Sec 5 3 Sample report 92 To analyze a sample lift the sample door The prompt Introduce Sample will be displayed and the pump will begin to aspirate Introduce
12. Due to this instrument operating principle analytical accuracy not only depends on correct operation and function but also upon a variety of external influences beyond the manufactur ers control Therefore the test results from this instrument must be carefully examined by an expert before further measures are taken based on the analytical results Instrument adjustment and maintenance with removed covers and connected power mains are only to be performed by a qualified technician who is aware of the dangers involved Instrument repairs are only to be performed by the manufacturer or qualified service personnel Symbol Explanation Attention symbol Refer to the Operator s Manual or Service Manual for further instructions This symbol is located on the inside of the instrument O Type B instrument symbol An instrument of the B type falls under safety categories I II or III or has an internal power supply providing the required insulation against discharge current and reliable ground comnections Important Information lii Operating Safety Information This instrument falls under Safety Category I This instrument is a Class B instrument This device complies with Part 15 of the FCC Rules Operation is subject to the following two conditions 1 this device may not cause harmful interference s and 2 this device must accept any interference received including interference that may cause undesired operation
13. K 4 0 0 164 Chloride 0 9631 1 01 0 9995 0 51 70 152 50 normalized to Cl 105 4 88 ionized Calcium 0 8898 0 107 0 9960 0 021 0 67 1 66 50 normalized to iCa 1 1 0 014 Lithium 0 9923 0 008 0 9985 0 010 0 11 0 71 15 xxi Correlation to Direct ISE flame correlated AVL 91XX Electrolyte Analyzers Correlation Parameter Slope Intercept Coefficient Sodium 0 9856 2 02 0 9856 normalized to Na 140 0 006 Potassium 0 9992 0 02 0 9994 normalized to K 4 0 0 02 Chloride 1 0026 5 31 0 9989 normalized to Cl 105 5 04 ionized Calcium 1 0023 0 040 0 9954 normalized to iCa I 1 0 042 Correlation to Chloridometry Labconco Digital Chloridometer Correlation Parameter Slope Intercept Coefficient Chloride 1 0222 2 0 9923 normalized to Cl 105 0 00 XXII Sy x 1 21 0 05 0 73 0 022 0 62 1 54 Sy x 2 03 Range 104 179 1 9 11 8 70 152 Range 66 145 50 50 50 50 50 Bibliography Bishop ML Duben Engelkirk JL Fody EP Clinical Chemistry Principles Procedures Correlations 2nd Ed Philadelphia J B Lippincott Co 1992 p 281 Burritt MF Pierides AM Offord KP Comparative studies of total and ionized serum calcium values in normal subjects and in patients with renal disorders Mayo Clinic Proc 55 606 1980 Burtis C Ashwood E Eds Tietz Textbook of Clinical Chemistry 2nd Ed Philadelphia W B Saunders Co 1994 pp 1354 1360 2180 2206 Calbreath Donald F Clinical Chemistry A
14. Khigh 25 1 ok If the standard K ranges are acceptable for your lab press YES If you wish to change the ranges to conform to your specific requirements press NO Y ou may now adjust the high and low values by using the NO key to change the number the YES key to accept the number The analyzer will now display the current CT 1f activated low and high values as such Cllow 97 Clhigh 111 ok If the standard Cl ranges are acceptable for your lab press YES If you wish to change the ranges to conform to your specific requirements press NO You may now adjust the high and low values by using the NO key to change the number the YES key to accept the number The analyzer will now display the current Ca 1f activated low and high values as such Ca low 1 12 Cahigh 1 32 ok If the standard Ca ranges are acceptable for your lab press YES If you wish to change the ranges to conform to your specific requirements press NO You may now adjust the high and low values by using the NO key to change the number the YES key to accept the number Note If the units for Ca were switched to mg dL for MGL Code see Service Codes the low and high values are displayed in mg dL units The analyzer will now display the current Li 1f activated low and high values as such Lilow 0 60 Lihigh 1 20 ok If the standard Li ranges are acceptable for your lab press YES If you wish to change the ranges to confor
15. Solution Parameter Sodium Potassium Chloride ionized Calcium Lithium Material Urine Parameter Sodium Potassium Chloride ionized Calcium Lithium mean 135 2 1 58 107 3 1 68 N A mean 51 5 48 4 85 9 N A N A ow CV 0 45 0 33 0 023 1 46 0 37 035 0 012 0 72 Swr 1 98 0 65 0 53 CV 3 84 1 34 0 62 Sad CV 0 36 0 28 0 041 0 92 1 00 0 93 0 031 2 64 0 015 8 40 odd CV 181 2 10 0 041 1 94 023 0 21 0 092 5 20 odd CV96 0 59 0 4496 0 031 1 95 0 63 0 59 0 016 0 96 Saa CV 3 06 5 94 0 97 2 00 0 66 0 76 St CV 047 0 34 0 051 1 13 124 1 16 0 039 3 29 0 023 13 28 Sr CV 1 78 2 0796 0 049 2 32 0 40 0 37 0 115 6 50 Sr CV 0 72 0 54 0 037 2 37 0 86 0 80 0 027 1 63 St CV 3 65 7 08 1 11 2 29 0 99 1 16 XIX Linearity in Aqueous Standard Solutions Aqueous linearity standards were gravimetrically prepared from N I S T traceable salts and mea sured on each of six AVL 9180 instruments two of each configuration Na K Cl Na K Ca and Na K La Parameter Sodium Potassium Chloride ionized Calcium Lithium Linearity in Serum olope 0 99993 0 99838 0 97556 1 01552 0 99850 Intercept 0 0128 0 0119 0 1775 0 0078 0 0087 Correlation Coefficient Sy x Range n 0 99995 0 666 51 196 300 0 99919 0 194 2 0 12 6 300 0 99994 0 674 56 194 100 0 99980 0 037 0 4 3 3 100 0 99985 0 038 0 3 5
16. YES and open the sample door to pump liquid through the sensor for measurement press NO to stop the pump press NO again to exit or to perform other service functions Testing the sample door To check the positioning of the sample door from the SERVICE FUNCTIONS display press NO until Test Sample Door appears Press YES Raise the sample door and the display should indicate that the door is open with an O in the upper right corner of the display Close the door and the O should change to a C indicating the door is closed Testing SnapPak Sensor Press YES to the prompt Test SnapPak Sensor I indicates that the pack is in place O indicates that the pack is either not present or not completely seated Ifthe ISE SnapPak has been removed during this test a calibration should be performed to prime all fluid lines 89 7 N eL n DA Ne EC f a Al Di Oh sl oe meee d e 7 1 Fluid control valves 90 Testing the language switch To check the current position and the performance of the language switch press YES in the Test Lan guage Switch menu The language switch is located behind the paper tray Remove the paper tray and use a pen to change the setting of the language switch The selected language will be displayed Note To activate a new language turn the analyzer off and back on Testing the peristaltic pump The peristaltic pump has four spe
17. and other diseases involving electrolyte imbalance Chloride Chloride is an anion that exists predominantly in extracellular spaces It maintains cellular integrity through its influence on osmotic pressure It is also significant in monitoring acid base balance and water balance In metabolic acidosis there 1s a reciprocal rise 1n chloride concentra tion when the bicarbonate concentration drops Decreased levels are found in severe vomiting severe diarrhea ulcerative colitis pyloric obstruction severe burns heat exhaustion diabetic acidosis Addison s disease fever and acute infections such as pneumonia Increased levels are found in dehydration Cushing s syndrome hyperventilation eclampsia anemia cardiac decompensation lonized Calcium Calcium in blood is distributed as free calcium ions 50 bound to protein mostly albumin 40 and 10 bound to anions such as bicarbonate citrate phosphate and lactate However only ionized calcium can be used by the body in such vital processes as muscular contraction cardiac function transmission of nerve impulses and blood clotting The AVL 9180 Analyzer measures the ionized portion of the total calcium In certain disorders such as pancreatitis and hyperparathyroidism ionized calcium is a better indicator for diagnosis than total calcium Vi Elevated calcium hypercalcemia may be present in various types of malignancy and calcium measurements may serve as biochemi
18. are printed on each container label Standard C Use Contents Active Ingredients Additives Storage Stability Reference Solution Use Contents Active Ingredients Additives Storage Stability For calibration of sodium potassium chloride 1onized calcium and lithium in the AVL 9180 Electrolyte Analyzer 85 mL Na 150 mmol L K 5 0 mmol L Cl 115 mmol L Ca 0 9 mmol L Er 1 4 mmol L Germicides Temperature 5 30 C 41 86 F Expiration Date amp Lot Number are printed on each container label A salt bridge for calibration and measurement in the AVL 9180 Electrolyte Analyzer 85 mL Potassium chloride 1 2 mol L Germicides Temperature 5 30 C 41 86 F Expiration Date amp Lot Number are printed on each container label Separately Packaged Reagents Cleaning Solution A BP1025 Use Contents Active Ingredients Additives Storage Stability XII For cleaning the AVL 9180 Analyzer measuring system Each dispensing bottle contains 100 mL of solution Neodisher MA detergent 3 5 g L none Temperature 5 30 C 41 86 F Expiration Date amp Lot Number are printed on each container label Conditioning Solution BP0380 Use Contents Active Ingredients Additives Storage Stability For daily conditioning of the sodium electrode and sample sensor in the AVL 9180 Analyzer Each dispensing bottle contains 100 mL of solution U S market Am
19. by the foam packaging materi als which are provided for shipping only Before you begin installing your system take a mo ment to look over the contents to ensure that you have everything you need to get your analyzer up and running Check for these items Power cord Electrodes Printer paper ISE SnapPak Cleaning Solution A Electrode Conditioning Solution ISE trol Electrolyte Control You will also need a supply of lint free tissues and disposable sample cups which should be kept in a location convenient to the analyzer Setting up Now you re ready to get your AVL Electrolyte Analyzer prepared to operate Prior to beginning the actual installation 1t is a good idea to completely read through this chapter to develop an understanding of the procedures that are required 2 2 Removing relief clamps A ad UE A 2 4 Electrode o ring Begin by placing the analyzer on a secure table top that allows plenty of working space and is convenient to a power connection Open the analyzer main door Locate and carefully remove the five red relief clamps from the valves by sliding out the clamps Save the clamps for reuse to prevent damaging the tubes in the event the analyzer is later shut down for any reason See illustration 2 2 Slip the two pump windings around the analyzer pump rollers making sure not to overstretch the tubing See illustration 2 3 Electrode
20. displayed Press YES and the prompt Print last Sample Report will be displayed Press NO The analyzer will now display Print Cal Report Press NO and Print QC Values and Statistics will appear Press YES and instrument will begin printing all values grouped by configuration For the statistics all values available for each parameter are used After printing the AVL Electrolyte Analyzer will return to READY Note If correlation factors are changed or OC values switched to direct ISE ALL values in memory are recalculated and printed in the new setting Chapter 5 Operation The AVL Electrolyte Analyzer provides fast conve nient analysis of whole blood serum plasma aqueous solutions dialysate solutions and urine for Na Sodium K Potassium Cl Chloride Ca Calcium Lr Lithium Ca and Li are not measured in urine samples The analyzer will accept specimens directly from most common containers including collection tubes sy ringes sample cups and capillary tubes Note Always follow proper safety procedures when handling biological samples All parameters are reported in mmol L However Ca if activated can be switched to mg dL see Service Codes Whole blood samples Collect the blood in a green top tube or heparinized syringe preferably with sodium heparin anticoagulant Note Lithium heparin may also be used if lithium is not installed 49 90 Whole blood samples shou
21. explosive anesthetic mixtures containing oxygen or nitrous oxide e This instrument is suitable for continuous operation e The power plug is to be plugged into a ground socket only When using an extension cord make sure that it is of the proper size and is properly grounded Any breakage of the ground lead inside or outside the instrument or a loose ground connection can cause a hazardous condition when operating the instrument Intentional disconnection of the grounding 1s not permitted When replacing the fuses make sure that they are of the same type and rating as the original fuses Never use repaired fuses or short circuit the fuse holders Operating Safety Information IV METHOD SHEET Intended Use The AVL 9180 Electrolyte Analyzer 1s intended to be used for the measurement of sodium potas sium chloride 1onized calcium and lithium in samples of whole blood serum plasma urine dialy sate and aqueous standard solutions Clinical Significance Sodium Sodium is the major cation of extracellular fluid Its primary functions in the body are to chemically maintain osmotic pressure and acid base balance and to transmit nerve impulses Sodium functions at the cell membrane level by creating an electrical potential between different cell membranes causing the transmission of nerve impulses and neuromuscular excitability to be maintained Sodium is involved in some enzyme catalyzed reactions as a cofactor The body h
22. plastic Measuring capillary sodium selective glass Electrolyte chamber airtight filled with electrolyte solution for Na electrodes Pin connector silver silver chloride Ag AgCl Use and Care AVL Sodium Electrodes are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the electrode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode since these will attack the plastic housing Store the electrode in a clean dry place only after the electrode has been cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seal should be installed in the electrode during storage O N O ring seal electrolyte chamber inner electrode capillary serial number connecting pin E J 8 3 Sodium electrode construction 102 Potassium Electrode Specifications The Potasstum Electrode is a membrane electrode used for in vitro diagnos tic measurement of potassium ions present in fluid samples It is designated with a K marking on the top surface of the housing Construction Electrode housing transparent acrylic plastic Measuring membrane potassium ion selective Electrolyte chamber airtight filled with electrolyte solution for K electrodes Pin connector silver silver chloride Ag AgCl Use and Care AVL Potassium Electrodes are manufactured for use in AVL 9180 Electro lyte Analyzer
23. programming feature allows you to customize the normal ranges that the AVL Electrolyte Analyzer will use to flag abnormal patient measurement values on both the display and printed report Programming normal ranges The AVL Electrolyte Analyzer is preset to standard direct normal ranges Na K flame photometry Na 136 145 mmol L Kr 35 5 1 mmol L CI 97 111 mmol L Ca 1 12 1 32 mmol L I 0 6 1 20 mmol L These parameters can be changed through the pro gramming menu to tailor the normal ranges to your lab specifications To change the normal ranges follow the steps at the beginning of this chapter that explain the PROGRAM INSTRUMENT display 1 Tietz Norbert W Ed Clinical Guide to Laboratory Tests 2nd edition Philadelphia W B Saunders Company 1990 pp 98 456 510 720 2 Henry R J Clinical Chemistry Principles and Technics New York Harper and Row 1974 31 32 Press NO until Program Normal Ranges is displayed Press YES and the current Na low and high values will be displayed as such Nalow 136 Nahigh 145 ok If the standard Na ranges are acceptable for your lab press YES If you wish to change the ranges to conform to your specific requirements press NO You may now adjust the high and low values by using the NO key to change the number the YES key to accept the number The analyzer will now display the current K low and high values as such Klow 3 5
24. the measurement values Other anticoagulants such as EDTA citrate oxalate and fluoride have a significant effect on blood electrolytes and should not be used For serum samples containers without additives are recommended Handling and Storage of Samples For ionized calcium values anaerobic conditions should be followed for all sample types Contact with ambient air will cause a loss of CO in the sample and the subsequent rise in pH will cause a reduction in ionized calcium Whole Blood Whole blood samples should be collected in a heparinized syringe AVL Microsampler or capillary and analyzed as soon as possible after collection The sample container should be filled as much as possible leaving minimal residual air space If brief storage is required do not cool the sample as the erythrocytes could burst and release the intracellular potassium creating an inaccurate potassium value in the sample Plasma Plasma samples should be obtained by immediately centrifuging heparinized whole blood separating the plasma from red cells and capping the sample tube Analyze as soon as possible If storage 1s required the samples should be capped and refrigerated at 4 to 8 C Refrigerated samples should be allowed to warm to room temperature 15 to 30 C prior to analysis If storage exceeds one hour the plasma sample must be recentrifuged to remove additional fibrin clots Serum Serum samples should be obtained by collecting bl
25. while the analyzer prepares for automatic calibration A countdown will be displayed as soon as the actual calibration cycle starts Note Calibration is an automatic process During this time the analyzer is conducting measurement operations to ensure the accuracy of the instrument Occasionally extended calibration is required Note It is very important that the main door is closed during calibration since it provides shielding from sources of electromagnetic interference When calibration is completed the analyzer will display READY indicating that the instrument is now prepared for quality control sampling 23 24 Selecting Parameter Configuration After completion of the daily maintenance procedure the analyzer starts an automatic calibration for sodium and potassium To select a different parameter configuration interrupt the calibration by pressing NO Continue pressing NO until OPERATOR FUNCTIONS is displayed Press YES followed by NO until the analyzer displays Select Parameter Configuration Press YES to display the current configuration The default configuration is displayed Selected Param Na K ok Press NO until the desired configuration is displayed then press YES to accept your selection Note If Na Li is selected only lithium is reported Install the Na electrode and calibrate for lithium Congratulations Your AVL Electrolyte Analyzer is ready for operation Chapte
26. 0 240 V 50 60 Hz self adjusting 1 4 A max 375 watts max 30 watts room temperature 15 32 C 60 90 F lt 85 relative humidity non condensing HxWxD 13 2 x 12 4 x 12 0 335 x 315 x 295 mm approx 13 lbs 6 kg I B according to OVE MG EN 60601 1 IEC 601 1 continuous operation IP 20 the device is not designed for operation in explosive environments CSA IEC 1010 TUV GS CE FCC Class B Data subject to change without notice Technical information is supplied for general informational purposes only 115 AVY NO S9A Program flow chart S9A S9A SINOLLONY 13 d ANMALSNI ONdNOLVAST WO ON SADINAAS ON IWW3IDO Y ON Appendix B 116 Appendix C Maintenance log master Note You may use this page as a master for duplicating Ni EHEN HE MEN Ni EAN m NL IP TT PT Y REA El ww MO QJ Li ow MO Ed MEN MEAN NON MEN O Ed DEN NO MEN N Ei ww NM El ww WM Ed MEN NO MEN O Ed MON MO MEN AVL 9180 ELECTROLYTE ANALYZER MAINTENANCE SCHEDULE PerfonmCleaning Cycle PerformConditioning Cycle Clean Sample Probe Fill Port Clean Analyzer Surfaces MONTH OF DAILY Appendix D Correlation factor worksheet master Note You may use this page as a master for duplicating Low Level reference device Low Level AVL eas no _ east
27. 160 mmol L K CV lt 15 4 6 mmol L Cl CV 1 0 90 130 mmol L Ca SD lt 0 02 mmol L 0 8 1 5mmol L Li SD lt 0 02 mmol L 0 4 1 3mmol L 1 300 mmol L l mmol L 4 5 120 mmol L 0 1 mmol L 60 120 with additional dilution 1 300 mmol L l mmol L Calcium and Lithium are not measured in urine samples Reproducibility within run Nat CV lt 5 100 250 mmol L E CV lt 5 10 60 mmol L CH CV lt 5 100 250 mmol L Operating Parameters Sample size Sample type Sample application Analysis time Sample rate Calibration Data management Diagnostic programs Electronics Display Printout Computer interface Data link Power requirements Nominal power consumption Temperature Humidity Dimensions Weight Classifications Safety category Device type Mode of operation Protection classification Explosion protection Approvals 95 uL whole blood serum plasma dialysate urine syringe sample cup collection tube capillary approx 50 sec 60 per hr without printout 45 per hr with printout fully automatic 1 and 2 point calibrations quality control memory storage 3 levels 35 days calculation of mean std deviation and coefficient of variation CV user controlled diagnostics plain language display microprocessor controlled dot matrix 2 lines 16 characters per line built in thermal paper roll printer 16 character width RS232C serial port Data link to Compact 2 10
28. 3 100 Linearity in serum was established with the analysis of two specimen sets in non clinical tests commercially prepared serum linearity standards for sodium chloride and potassium with normal protein content and a group of random patient serum samples All samples were analyzed in pairs on each of two of AVL 9180 instruments in each configuration Na K Cl Na K iCa and Na K Li and in pairs on each of the following instrument types for comparision to various methods Direct ISE not flame correlated listed as 98X Direct ISE flame correlated listed as 91X X Flame Absorbance Emission Spectroscopy Chloridometry XX AVL 983 Na K Cl Analyzer AVL 984 Na K iCa Analyzer AVL 985 Na K L Analyzer AVL 9130 Na K Cl Analyzer AVL 9140 Na K iCa Analyzer IL 943 Flame Photometer Labconco Digital Chloridometer Correlation to Flame IL 943 Flame Photometer Correlation Parameter Slope Intercept Coefficient Sy x Range n Sodium 0 9617 5 83 0 9908 2 04 104 178 50 normalized to Na 140 0 47 Potassium 1 0249 0 015 0 999 0 075 1 8 11 5 50 normalized to K 4 0 0 11 Lithium 0 9803 0 011 0 9822 0 028 0 11 0 71 15 0 9720 0 016 0 9957 0 019 0 23 1 13 15 Correlation to Direct ISE not flame correlated AVL 98X Electrolyte Analyzers Correlation Parameter Slope Intercept Coefficient Sy X Range n Sodium 0 9895 6 35 0 9992 0 61 110 186 50 normalized to Na 140 7 83 Potassium 1 0223 0 25 0 9996 0 05 2 0 11 6 50 normalized to
29. 5 86 ERR If the unit displays ERR instead of the sample results no valid voltage reading could be obtained from the electrode Possible remedies e Check for proper sample preparation see Chapter 5 e Check for proper connection of the electrodes e Check for proper filling of the reference housing e Check for air bubbles in the sample PERFORM DAILY MAINTENANCE This message will be printed at the end of a sample report when cleaning or conditioning have not been performed within the last 24 hours This message is printed only Possible remedy e Perform daily maintenance CHANGE FLUID PACK When the monitored fluid level in the ISE SnapPak reaches 5 remaining the analyzer will automatically print CHANGE FLUID PACK at the end of each sample report This message is printed only Possible remedy e Replace the ISE SnapPak See Checking Reagent Fluid Level and Changing the ISE SnapPak in Chapter 6 L CALCULATION NOT POSSIBLE The lithium result can only be calculated for a Na range of 95 180 mmol L 89 6 169 5 mmol L for blood serum Ifthe Na value of the sample is outside of this range will be displayed and printed instead of the Li value CHECK TEMP Ca activated This message is printed at the end of the sample report and displayed while the measurement is in process in case the temperature of the sample is outside the range Range 10 C 40 C The sample resu
30. 5000 YAOIII YA0836 PD5006 PD5008 US0285 BP5014 BP5202 Most often problems can be resolved over the tele phone getting the analyzer back in service within minutes Our technicians have the training and experi ence you can rely on for dependable technical assis tance AVL s STATService Hotline U S Market only 1s staffed to provide immediate troubleshooting assis tance seven 7 days per week twenty four 24 hours per day Should you need troubleshooting assistance or appli cation information regarding your AVL Electrolyte Analyzer just contact AVL s STATService Hotline In the U S call 1 800 526 2272 Should you require additional service support our STATService Hotline can provide complete details on all available service options and ensure that any instrument down time is minimized Warranty Registration U S market only After successful completion of the installation of your new AVL Electrolyte Analyzer 1t will be necessary to complete the Installation and Instrument Warranty Report form enclosed It is necessary for this docu ment to be completed and returned to AVL to ensure proper warranty support should you require warranty assistance The model and serial numbers can be found directly behind the front cover on the right hand side above the sample probe mechanism Please read the Instrument Warranty Terms and Conditions to become familiar with the agreement Each new analyzer purchased is provid
31. B Standard C Allowable Difference A B A C Na 600 to 2400 1600 to 2000 600 to 2400 250 to 680 50 to 50 K 700 to 1000 2500 to 500 700 to 1000 470 to 1200 40 to 40 Cr 3100 to 100 1000 to 3000 3100 to 100 370 to 860 not used Ca 3100 to 1000 2300 to 2500 3100 to 1000 350 to 660 150 to 150 Li 3100 to 1900 3600 to 1400 2600 to 3400 1 to 760 1730 to 285 Note If the voltage difference A B or A C is outside the allowable difference perform daily maintenance or replace the electrode After testing the electrodes against the standard solutions the AVL Electrolyte Analyzer will prompt Test External Sample Press YES The instrument will prompt Open Sample Door Introduce Sample Introduce the sample to the probe until the prompt Remove Sample and Wipe Probe is received After closing the sample door the voltages will automatically appear Check for stable readings Press NO to exit and after a short Please Wait message the prompt Remain in Test Electrodes will appear Press NO to exit or to perform other service functions Testing the sample sensor The sample sensor must provide a reading of 80 120 when air is detected and should indicate at least 40 higher when clear liquid is passed through the sensor To check the sample sensor from the SERVICE FUNCTIONS display press NO until Test Sample Sensor appears Press YES The analyzer will display the normal range and the measured value Press
32. CE ERROR This message will only be displayed during the TEST INTERFACE function Testing the inter face requires jumping pins 2 and 3 of the interface receptacle During the test the analyzer sends out the characters A V L and checks if they are received within a set time period Possible remedies e Check to see if pins 2 and 3 are jumped correctly Make sure jumper does not touch ground e Contact AVL for technical assistance PAPER JAM OR PRINTER DEFECT If the printer attempts to print to the paper and the paper jams in the feeder PAPER JAM OR PRINTER DEFECT will be displayed briefly then the sample results will appear on the display Possible remedy e First turn analyzer off then remove the printer by placing your index finger behind the back edge of the printer module and pull it forward Remove the jammed paper and reinsert the printer into the analyzer Turn analyzer back on Note To ease removal of jammed paper the printer head can be moved by turning the spindle gear on the left side Note Paper jams should be cleared as soon as possible to avoid damaging the printer CHECK ELECTRODES If none of the electrodes passes the calibration the CHECK ELECTRODES message will be displayed There are several possible reasons for an electrode not passing calibration Either a stable reading of Stan dard A could not be obtained within 6 aspirations of Standard A or the slope A B or A C is outside of the lim
33. Calcium Lithium mean 150 0 4 97 115 0 0 96 0 30 ow CV 0 55 0 37 0 022 0 44 0 11 0 09 0 004 0 41 0 004 1 27 Material Aqueous Standard Solution Level 2 Parameter Sodium Potassium Chloride ionized Calcium Lithium mean 113 2 1 82 82 9 2 43 5 42 ow CV 0 51 0 45 0 033 1 88 027 0 33 0 014 0 56 0 043 0 78 Sdd 0 76 0 026 0 89 0 007 0 063 Sdd 0 45 0 021 0 42 0 004 Sdd 0 34 0 018 0 08 0 004 0 005 CV 0 48 0 45 0 72 1 07 2 44 CV 0 33 0 42 0 41 0 40 CV 0 23 0 36 0 07 0 39 1 60 odd CV 0 96 0 043 0 67 0 032 0 155 0 85 2 36 0 80 1 33 2 86 ST CV 0 90 0 036 1 17 0 014 0 082 0 56 0 62 0 95 2 2070 3 18 ST CV 0 63 0 043 0 58 0 011 ST 0 57 0 029 0 16 0 007 0 008 0 47 0 88 0 57 0 95 CV 0 38 0 57 0 14 0 76 2 48 ST CV 1 07 0 053 0 87 0 043 0 196 0 95 2 92 1 05 1 76 3 62 Material Pooled Human Serum mean Parameter Sodium Potassium Chloride ionized Calcium Lithium 138 8 4 49 106 8 1 19 0 17 Swr 0 30 0 034 0 18 0 007 0 011 Material Acetate Dialysate Solution ow CV Parameter Sodium Potassium Chloride ionized Calcium Lithium mean 36 1 2 09 107 8 1 77 N A 0 85 CV 0 22 0 75 0 17 0 55 6 19 0 98 0 029 1 41 0 25 0 24 0 020 1 13 Material Bicarbonate Dialysate
34. Fundamental Textbook Philadelphia W B Saunders Co 1992 pp 371 376 390 395 Henry R J Clinical Chemistry Principles and Technics New York Harper and Row 1974 Kost GJ Arch Path Lab Med Vol 117 Sep 1993 p 890 95 National Committee for Clinical Laboratory Standards Protection of Laboratory Workers from Infectious Disease Transmitted by Blood Body Fluids and Tissue Second Edition Tentative Guideline NCCLS Document M29 T2 1992 National Committee for Clinical Laboratory Standards Additives for Blood Collection Devices Heparin Tentative Standard NCCLS Document H24 T 1988 National Committee for Clinical Laboratory Standards Evaluation of Precision Performance of Clinical Chemistry Devices Second Edition Tentative Guideline NCCLS Document EP5 T2 1992 Rose Burton David Clinical Physiology of Acid Base and Electrolyte Disorders 4th Ed New York McGraw Hill Inc 1993 pp 346 348 432 797 798 Schoeff Larry E amp Williams Robert H Eds Principles of Laboratory Instruments St Louis Mosby Year Book Inc 1993 pp 150 157 161 164 Snyder John R Senhauser Donald A Eds Administration and Supervision in Laboratory Medicine 2nd Ed Philadelphia J B Lippincott Co 1989 pp 262 284 Tietz Norbert W Ed Clinical Guide to Laboratory Tests 2nd Ed Philadelphia W B Saunders Co 1990 pp 98 99 118 119 456 459 510 511 720 721 Tietz Norbert W Ed Textbook of Clinical Ch
35. MEDICALINSTRUMENTS 9180 Electrolyte Analyzer Operator s Manual AVE 2nd Edition June 1996 Copyright 1996 AVL Scientific Corporation All rights reserved Unless otherwise noted no part of this publication may be reproduced transmitted transcribed stored in a retrieval system or translated into any language in any form without the written permission of AVL Scientific Corporation For information contact AVL Scientific Corporation AVL MEDICAL INSTRUMENTS AG AVL LIST GmbH 50 Mansell Court Stettemerstrasse 28 Kleiststrasse 48 P O Box 337 CH 8207 Schaffhausen A 8020 Graz Roswell Georgia USA 30077 Switzerland Austria 1 800 526 2272 41 848 800 885 43 3 16 987 Printed in USA PD5006 REV B Important Information This Operator s Manual contains important warnings and safety information to be observed by the user This instrument is only intended for one area of application which 1s described in the instruc tions The most important prerequisites for application operation and safety are explained to ensure smooth operation No warranty or liability claims will be covered if the instrument 1s applied in areas other than those described or if the necessary prerequisites and safety mea sures are not observed The instrument is only to be operated by qualified personnel capable of observing these prerequisites Only accessories and supplies either delivered by or approved by AVL are to be used with the instrument
36. OPERATOR FUNCTIONS menu Press YES followed by NO until Select Parameter Configuration appears Press NO until the desired configuration is displayed Note The Na in parenthesis indicates that the Na result is not displayed the Na parameter however has to be present to allow for lithium calibration After confirming the desired parameter configuration by pressing YES the instrument returns to READY if no new parameter has been activated If one or several new parameters have been selected the ana lyzer will enter the maintenance menu where a cleaning and conditioning routine has to be performed followed by an automatic calibration 69 70 Resetting the sample number Each time a sample is analyzed the analyzer will automatically advance the sample counter Iffor any reason you wish to reset the counter you can do so by entering the OPERATOR FUNCTIONS menu and press NO until Reset Sample Number is displayed To reset the sample number to zero 0 press YES The analyzer will prompt Are you sure Press YES and the sample number will be reset to zero Press NO to decline Take out of operation The take out of operation routine assists you in performing a complete shutdown of the analyzer A complete shutdown may be indicated to prepare the analyzer for shipping or in case the analyzer is not being used for an extended period of time For this procedure you will need a special shutdown kit BP5014 not sup
37. above the measur ing chamber Check that an o ring 1s present in the right electrode holder See illustration 2 9 Now install the electrodes in the measuring chamber beginning on the right and working to the left the reference electrode will be installed last Note The electrode on the right may be one of the following chloride ionized calcium lithium or a dummy electrode if no third test is needed If sodium and lithium are selected the K electrode is replaced by a dummy electrode Check to make sure that the lettering on the measur ing chamber matches the lettering on the electrode Also note that all electrodes have a lip on the bottom that rests on the flat edge of the measuring chamber to aid in proper positioning See illustration 2 10 Close the clamp on the left electrode holder by lifting it upward until it locks in the back position and ensure that the electrodes are properly seated See illustration 2 11 17 7 K Ne 2 14 Power cord installation 18 Slide the measuring chamber back until it snaps into position See illustration 2 12 Plug the tubing connector of the reference housing assembly into the receptacle below the left side of the measuring chamber See illustration 2 13 Preparing the analyzer for operation Before the analyzer is powered on the language setting must be selected The factory set language is English to select a diffe
38. action with the corresponding 10ns contained in the sample being analyzed The membrane is an ion exchanger reacting to the electrical charge of the 10n causing a change in the membrane potential or measuring voltage which is built up in the film between the sample and the membrane A galvanic measuring chain within the electrode determines the difference between the two potential values on either side of the membrane The galvanic chain 1s closed through the sample on one side by the reference electrode reference electrolyte and the open terminal The membrane inner electrolyte and inner electrode close the other side A difference in 10n concentrations between the inner electrolyte and the sample causes an electro chemical potential to form across the membrane of the active electrode The potential 1s conducted by a highly conductive inner electrode to an amplifier The reference electrode 1s connected to ground as well as to the amplifier The 1on concentration in the sample is then determined by using a calibration curve determined by measured points of standard solutions with precisely known ion concentrations Viii Specimen Collection and Handling Safety Universal precautions must be observed when collecting blood specimens It is recommended that all blood specimens be handled as potentially infectious specimens capable of transmitting human immunodeficiency virus HIV hepatitis B virus HBV or other bloodbor
39. am QC Level 1 Ranges menu while NO will return the analyzer to READY 39 40 Chapter 4 Quality Control Running a QC sample To monitor the performance of your AVL Electrolyte Analyzer you should run daily quality control samples using AVL ISE trol Electrolyte Control HC0033 These protein based ISE controls allow you to moni tor the analysis of sodium potass um chloride ionized calcium and lithium and have been specially formulated for use with your AVL Electrolyte Ana lyzer Note You can store in memory up to 35 QC mea surements per level You can print the values stored and view the statistics at any time ISE trol is provided in three levels to produce ex pected values that are low normal and high allowing thorough evaluation of the analyzer s performance Whenever a new box of ISE trol is opened be sure to enter the lot number information into the analyzer as detailed in Chapter 3 Note ISE trol should be stored in the refrigerator at 2 8 C and brought to room temperature before use From the READY display press NO until the prompt QC STD DIALYSATE URINE SAMPLE appears Press YES The prompt QC Level 1 Sample will be displayed 43 AQ y utes 77 4 1 Introducing Level 1 control qum NS N lt a ES 4 2 Cleaning probe 44 Press YES The prompt Open Sample Door Introduce Sample will be displayed Remove a Level 1 amp
40. amples XIV Calibration The analyzer contains software which permits one of six parameter configurations Na K Ca Na K CH Na K Lr Na K Na Li Li Each of these configurations uses the same calibration solutions A 2 point calibration is performed automatically every 4 hours in READY mode and a 1 point calibra tion 1s automatically performed with every measurement An automatic calibration procedure 1s also performed shortly after power on or reset A calibration cycle can also be initiated manually at times when no sample measurements are performed Quality Control AVL recommends that at least once daily or in accordance with local regulations quality control solutions with known Na K Cl Ca and Li values should be analyzed at two levels normal and low or high For further details please review the Quality Control section of the Operator s Manual Results obtained should fall within limits defined by the day to day variability of the system as mea sured in the user s laboratory If the results fall outside the laboratory s acceptable limits refer to the Troubleshooting Section of the Operator s Manual Reference Interval Specimen Reference Ranges Na Kt Ca Cr Ir mmol l mmol L mmol L mmol L mmol L serum plasma whole blood 136 145 3 5 5 1 1 12 1 32 97 111 0 6 1 20 urine mmol 24hrs 40 220 25 125 N A 110 250 N A The ranges are provided for referenc
41. and potassium are reported by default as flame photometry equivalent values chloride ionized calcium and lithium are reported as ISE direct potentiometry values The urine mode allows for the measurement of prediluted urine samples for sodium potassium and chloride The acetate bicarbonate and standard mode allows for the measurement of aqueous solutions and reports as ISE direct potentiometry values For details of this operation please refer to the Operator s Manual Test Conditions Sample Size 95 uL Sample Types Whole blood serum plasma urine acetate and bicarbonate dialysate solutions Sample Container capillary AVL Microsampler syringe collection tube sample cup Ambient Temperature 15 to 32 C 60 to 90 F Relative Humidity 5 to 85 non condensing Type of Measurement direct potentiometry Measured Parameters Parameter Measurement Range Display Resolution Whole blood serum plasma dialysate and aqueous solutions Sodium 40 205 mmol L 1 or 0 1 mmol L Potassium 1 5 15 mmol L 0 1 or 0 01 mmol L 0 8 I5 mmol L dialysate Chloride 50 200 mmol L 1 or 0 1 mmol L ionized Calcium 0 2 5 0 mmol L 0 01 or 0 001 mmol L Lithium 0 1 6 0 mmol L 0 01 or 0 001 mmol L Lithium is not measured in dialysate samples Urine Sodium 1 300 mmol L l mmol L Potassium 4 5 120 mmol L 0 1 mmol L 60 120 with additional dilution Chloride 1 300 mmol L l mmol L Calcium and Lithium are not measured in urine s
42. as a strong tendency to maintain a total base content and only slight changes are found even under pathologic conditions Low sodium values hyponatremia usually reflect a relative excess of body water rather than a low total body sodium Reduced sodium levels may be associated with low sodium intake sodium losses due to vomiting or diarrhea with adequate water and inadequate salt replacement diuretics abuse or salt losing nephropathy osmotic diuresis metabolic acidosis adrenocortical insufficiency congeni tal adrenal hyperplasia dilution type due to edema cardiac failure hepatic failure and hypothyroidism Elevated sodium values hypernatremia are associated with conditions with water loss in excess of salt loss through profuse sweating prolonged hyperpnea severe vomiting or diarrhea diabetes insipidus or diabetic acidosis increased renal sodium conservation in hyperaldosteronism Cushing s syndrome inadequate water intake because of coma or hypothalamic diseases dehydration or excessive Saline therapy The sodium value obtained may be used n the diagnosis or monitoring of all disturbances of the water balance infusion therapies vomiting diarrhea burns heart and kidney insufficiencies central or renal diabetes insipidus endocrine disturbances and primary or secondary cortex insufficiency of the adrenal gland or other diseases involving electrolyte imbalance Tietz Norbert W Ed Clinical Guide to Laboratory T
43. cal markers In general while ionized calcium may be slightly more sensitive either ionized or total calcium measurements have about equal utility in the detection of occult malignancy Hypercalcemia occurs commonly in critically ill patients with abnormalities in acid base regulation and losses of protein and albumin which gives a clear advantage to monitoring calcium status by ionized calcium measurements Patients with renal disease caused by glomular failure often have altered concentrations of calcium phosphate albumin magnesium and pH Since these conditions tend to change ionized calcium independently of total calcium ionized calcium is the preferred method for accurately monitoring calcium status in renal disease Ionized calcium 1s important for diagnosis or monitoring of hypertension management parathyroidism renal diseases inadequate calcium intake vitamin D monitoring dialysis patients cancer pancreatitis effect of diuretics malnutrition kidney stones multiple myeloma and diabetes mellitus Lithium Lithium is a monovalent alkali metal which 1s usually absent in the human body It 1s used in the treatment of manic depression psychosis The drug has proven highly effective in its intended use but some clinically significant complications have been associated with its use Lithium binding to the plasma proteins is less than 10 and its half life 1s 7 35 hrs It is mainly eliminated from the body by urine 95 Lit
44. ctive strip Save this cover to close the connectors prior to disposal of the used pack Write the installation date on the label of the new pack Note Once the protective strip is removed be sure to keep the pack upright to avoid spillage 6 Slide the new ISE SnapPak into position on the left side of the analyzer The analyzer will prompt New SnapPak installed See illustration 6 21 7 Press YES to indicate that a new ISE SnapPak is installed Press NO if you reinstall the pack that was removed 8 Press YES and the AVL Electrolyte Analyzer will automatically reset the fluid pack counter to 100 and commence system calibration Standby mode The AVL Electrolyte Analyzer 1s designed to calibrate automatically every four hours during normal opera tion If sampling will be delayed for an extended period of time such as evenings and weekends you may place the analyzer into Standby mode to suspend automatic calibration 67 68 Note Your analyzer can be programmed to auto matically enter Standby mode For instructions see Service Codes in Chapter 7 To access this mode follow the steps below 1 Press NO until the prompt OPERATOR FUNCTIONS is displayed Press YES 2 Press NO until the prompt Go to Standby Mode is displayed and press YES 3 The analyzer will display STANDBY YES gt READY to confirm that it has entered Standby mode To leave Standby and resume normal operation 1 Press NO The p
45. ctor 60 Performing weekly maintenance On a weekly basis or whenever necessary you should clean the sample fill port and sample probe illustra tion 6 3 as well as the exterior analyzer surfaces Cleaning should also be performed on a weekly basis if fewer than five samples are analyzed a day To clean the sample fill port and probe open the sample door and clean the fill port probe and surrounding area with a damp cotton swab When finished close the sample door If the analyzer at tempts to perform a sample analysis NO Sample will be briefly displayed and the unit will return to READY The exterior surfaces should be wiped clean with a soft damp cloth Note Never use strong or abrasive cleaners on the AVL Electrolyte Analyzer Use a slightly damp cloth to avoid getting fluid inside the analyzer Performing monthly maintenance Monthly maintenance involves cleaning the reference electrode housing and should be performed prior to daily maintenance To complete this procedure you will need a small amount of household bleach Begin monthly maintenance by pressing NO until DAILY MAINTENANCE is displayed Press YES and Perform Daily Cleaning will appear Do not press any keys Open the front cover of the analyzer Unplug the tubing of the reference electrode from the receptacle below the left side of the measuring chamber See illustration 6 4 6 5 Sliding measuring chamber to front locked pos
46. ctrode has been cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seal should be installed in the electrode during storage a ion selective membrane O ring seal electrolyte chamber measuring capillary serial inner number electrode ein 8 5 Chloride electrode construction Calcium Electrode Specifications The Calcium Electrode is a membrane electrode used for in vitro diagnostic measurement of calcium ions present in fluid samples It 1s designated with a Ca marking on the top surface of the housing Construction Electrode housing transparent acrylic plastic Measuring membrane calcium ion selective Electrolyte chamber airtight filled with electrolyte solution for Ca electrodes Pin connector silver silver chloride Ag AgCI Use and Care AVL Calcium Electrodes are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the electrode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode since these will attack the plastic housing Store the electrode in a clean dry place only after the electrode has been cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seal should be installed in the electrode during storage ion selective N membrane O ring seal electrolyte chamber measuring capillary serial l number inner connect
47. d Close Sample Door is displayed Use a lint free tissue to remove the cleaning solution from the probe and close the door See illustration 6 2 The analyzer will now display Thank You and a brief countdown will begin While the countdown is running open the bottle of AVL Electrode Condition ing Solution and pour a small amount into a clean container After the countdown 1s completed the system will prompt Perform Daily Conditioning To con tinue with the procedure press YES The prompt Open Sample Door Introduce Sample will be displayed Lift the sample door and the pump will begin to aspirate Introduce the condi tioning solution to the sample probe Continue holding the solution under the sample probe until the prompt Wipe Probe and Close Sample Door is displayed After wiping the probe and closing the sample door the analyzer will display Thank You Upon completion of the countdown the prompt Remain in Daily Maintenance will be displayed Press NO and the AVL Electrolyte Ana lyzer will automatically initiate a calibration cycle Note It is very important that the main door is closed during calibration since it provides shielding from sources of electromagnetic interference When calibration is completed the analyzer will display READY indicating that the instrument is prepared to conduct electrolyte sampling 59 6 3 Fill port k 6 4 Removing reference conne
48. e blood and the dialysate are different a gradient will be formed at the membrane and thus smaller molecules are activated to diffuse through the membrane This method is effectively used to remove substances like urea uric acid which are unable to excrete from the blood because of renal insufficiency When the concentration of the electrolytes between the blood and dialysate liquid deviates signifi cantly the electrolytes diffuse in the direction towards the lower concentration 1 e from blood into the dialysis liquid or vice versa Analysis of electrolytes in dialysis 1s of immense clinical signifi cance and provides useful information to the clinician The use of ISE s in dialysis are To control the patient s electrolyte balance before during and after the dialysis for fast recognition of deviations and also for making early corrections To control the electrolyte concentrations in the dialysis liquid Normally they are prepared by mixing appropriate concentrations of the substances with a defined quantity of distilled water Principles of Procedures The AVL 9180 Analyzer methodology 1s based on the ion selective electrode ISE measurement principle to precisely determine the measurement values There are six different electrodes used in the AVL 9180 Electrolyte Analyzer sodium potassium chloride ionized calcium lithium and a reference electrode Each electrode has an ion selective membrane that undergoes a specific re
49. e only Each laboratory should establish its own reference interval for Na K Cl Ca and Li as performed on the AVL 9180 Electrolyte Analyzer Henry R J Clinical Chemistry Principles and Technics New York Harper and Row 1974 XV Limitations of the Procedure A number of substances have been reported to cause physiological changes in blood serum and plasma analyte concentrations A comprehensive discussion concerning these and other interfering substances their blood serum or plasma concentrations and their possible physiological involvement is beyond the scope of this method sheet No significant effect on serum and urine has been demon strated from bromide ammonium and iodide As with any clinical reaction users must be alert to the possible effect on results due to unknown interference from medications or endogenous substances All patient results must be evaluated by the laboratory and the physician in light of the total clinical status of the patient Opening and closing the fist with a tourniquet in place results in an increase in potassium levels by as much as 10 to 20 It is recommended that the blood sample be obtained without a tourniquet or that the tourniquet be released after the needle has entered the vein and 2 minutes elapsed before the sample is drawn Since the concentration of potassium inside erythrocytes 1s much greater than that in extracellular fluid hemolysis should be avoided a
50. e the intercept b and slope m Programming the printer The AVL Electrolyte Analyzer allows convenient operator programming of the printing functions for automatic printing of patient sample reports printing two copies of the sample report and auto matic calibration reports The analyzer printing default is set to automatically print one sample report after conducting an analysis but not to automatically print the calibration reports To change the default setting enter the programming menu Follow the steps at the beginning of this chapter that explain the PROGRAM INSTRU MENT display and enter the operator code Press NO until Program Printer Setup appears Press YES and the analyzer will prompt Patient Report Off Select NO if you want the analyzer to automatically print a sample report after each analysis or YES if an automatic report is not required Note If you select YES you will advance to the Automatic Cal Report prompt If you select NO the analyzer will display Print two Patient Reports Press YES if you want the AVL Electrolyte Analyzer to automatically produce two reports NO to decline oF 38 The analyzer will display Automatic Cal Report Select YES if you want a printed calibration report after each calibration or NO if an automatic report is not required Note The PRINT FUNCTIONS menu allows you to print a copy of the last sample report as well as the last calibration report The analyz
51. ed with a one year warranty from the date the analyzer 1s placed into service Electrodes are provided with product war ranties as indicated on AVL s price list The warranty period for electrodes varies depending on the specific type of electrode Electrode warranties begin from the date of shipment Contact AVL s STATService Hotline for any assis tance regarding warranty assistance or support 113 114 Appendix A Technical specifications Electrodes Sodium Na Sensor Potassium K Sensor Chloride Cl Sensor Calcium Ca Sensor Lithium Li Sensor Reference System Measuring Ranges mmol L Parameter ion selective flow through glass capillary electrode ion selective flow through liquid membrane electrode ion selective flow through liquid membrane electrode ion selective flow through liquid membrane electrode ion selective flow through liquid membrane electrode open liquid junction flow through electrode Measurement Range Display Resolution Whole blood serum plasma dialysate and aqueous solutions Sodium Potassium Chloride ionized Calcium Lithium 40 205 mmol L 1 or 0 1 mmol L 1 5 15 mmol L 0 1 or 0 01 mmol L 0 8 15 mmol L dialysate 50 200 mmol L 1 or 0 1 mmol L 0 2 5 0 mmol L 0 01 or 0 001 mmol L 0 1 6 0 mmol L 0 01 or 0 001 mmol L Lithium is not measured in dialysate samples Reproducibility within run Urine Sodium Potassium Chloride Na CV lt 1 0 140
52. eds of operation that can be automatically checked From the SERVICE FUNCTIONS display press NO until Test Pump appears Open the front cover and press YES The pump will progressively display Very Slow Speed Slow Speed Medium Speed and Fast Speed and an audible change should be heard in the pump s speed of operation Close the front cover and press NO to exit or perform other service functions Note The pump speed is electronically controlled and does not require any adjustment Testing the valves The AVL Electrolyte Analyzer has five valves that function automatically during the operation of the instrument See illustration 7 1 Open the analyzer front cover From the SERVICE FUNCTIONS display press NO until Test Pinch Valves appears Press YES Test Valve A YES NO ON OFF will appear When you press the YES button you should see the valve move into the open position Pressing NO will close the valve Pressing NO again will move to the next successive valve After testing all valves close the front cover and press NO to exit or perform other service functions Testing the interface Testing the serial interface allows you to verify the proper operation of the interface circuit From the SERVICE FUNCTIONS display press NO until Test Interface Jump Pins 2 and 3 appears Jump pins 2 and 3 making sure not to short the jumper to ground Press YES During the interface test the instrument sends out the charact
53. emistry 2nd Ed Philadelphia W B Saunders Co 1986 pp 1816 1837 1840 1842 1845 Toffaletti J Gitelman JH Savory J Separation and quantification of serum constituents associated with calcium by gel filtration Clin Chem 22 1968 72 1976 XXIII XXIV Preface Welcome Your AVL Electrolyte Analyzer is a powerful tool designed to help you quickly accurately and effi ciently conduct basic electrolyte testing in the conve nience of your own laboratory This manual will help guide you through setting up your analyzer and will help you start analyzing samples As you become familiar with the operation of the unit you may use the manual as a reference for day to day routines and as a guide for mainte nance and troubleshooting How to use this manual If you have an analyzer that is not yet set up you should begin by reading Chapters 1 and 2 For programming and quality control functions read Chapters 3 and 4 Information on analyzer opera tion and maintenance 1s contained in Chapters 5 and 6 Detailed service information and operating principles can be found in Chapters 7 and 8 XXV XXVI Contents Chapter 1 Getting to Know Your AVL Electrolyte Analyzer eri l Chapter 2 Installation nr Dee ENUMERARE 11 Chapter 3 Programming oooooooooooooooocnnnnonononnnnnnnnonnnnnnnonnnonnnnncninin s 25 Chapter 4 Quality C OBLEOL en ee nee ee 41 Chapter 5 Operation ooooooooooooooooooooononononnnnonnnnnnnnono
54. er displays Program Comment Line In this menu a comment up to 16 characters can be programmed which will be printed after the header on each report After pressing YES to the Program Comment Line display the prompt Enter Com ment appears Press NO to scroll through the letters of the alphabet and numbers 0 9 press YES to accept your selection Press NO to move the cursor to the next character After completing printing programming functions the menu Program Interface will be displayed Press YES and the prompt Activate Data link appears Press YES if you wish to interface the AVL 9180 with an AVL Compact 2 blood gas analyzer The data link with the AVL Compact 2 blood gas analyzer allows you to combine ISE results with pH blood gas results on one printout If Ca is activated on the 9180 a pH corrected Ca value will be calculated and printed on the combined sample report For connection of the 9180 analyzer to the Compact 2 analyzer the optional Interface Kit BP5202 is required To install the kit first turn both instruments off Connect the interface filter provided in the kit to the RS232 port on the 9180 Then connect one end of the cable to the interface filter the other end to the COM 2 port on the Compact 2 On the Compact 2 select 9180 under the COM2 interface options See Compact 2 Operator s Manual for Details The analyzer will then display Remain in Program Func Pressing YES will return you to the Pro gr
55. ers A V L and checks if they are received within a set time period Press NO to exit or to perform other service functions Testing the amplifier The amplifier voltage can be checked from the SERVICE FUNCTIONS display Press NO until Test Amplifier appears Press YES The analyzer will automatically test and display the voltage levels of the electrode channels Press NO and the ground and offset voltage will be displayed If Ca is activated press NO to view the temperature voltage and the temperature in degrees C Press NO to exit or to perform other service functions 91 92 Service Codes The Enter Service Code menu allows the pro gramming of various functions into the unit To enter a service code go to the SERVICE FUNCTIONS display press NO until Enter Service Code appears Press YES The instrument will display Enter Code Enter the desired service code by pressing NO to each letter until the correct letter is displayed then press YES After entering the code the analyzer will prompt Code Accepted then it will display Enter another Ser vice Code Press YES to do so NO to exit Note If an incorrect code is entered during the process the analyzer will prompt Code Error Retry Press YES to correct the code or NO to exit To remove a service code enter the reversed sequence of the code letters example DEC becomes CED ECO becomes OCE MGL becomes LGM etc To clear all service codes at one time en
56. es e Check for proper filling of the reference housing Ensure that the reference tubing is securely con nected to the receptacle e Since this test utilizes Standard A make sure that it is aspirated properly into the measuring chamber If not replace the ISE SnapPak e Clean the reference housing See Performing Monthly Maintenance in Chapter 6 PLEASE CLOSE SAMPLE DOOR This message occurs when the sample door is not closed within 20 seconds after the sample 1s in place or when the door has been opened and no sample is detected Possible remedy e Close the sample door within time allowed NO SAMPLE Under certain conditions the analyzer may not detect the presence of a sample and an error message will occur This could be caused by the sample door remaining open more than 20 seconds after samples are in place air bubbles in the sample a sample volume too small to analyze or no sample being aspirated through the sampling mechanism If you wish to abort a sample you can do so by closing the sample door during sample aspiration Possible remedies First repeat the sample to see if it is detected properly on a second trial Close the sample door within time allowed Check sample aspiration and look for the presence of clots in the sampling system Check for the presence of o rings and for proper sealing of the electrodes Ensure that the sample sensor is plugged in and perform TEST SAMPLE SENSOR to verify tha
57. ests 2nd Ed Philadelphia W B Saunders Co 1990 p 98 99 118 119 456 459 510 511 720 721 Burtis C Ashwood E Eds Tietz Textbook of Clinical Chemistry 2nd Ed Philadelphia W B Saunders Co 1994 pp 1354 1370 Potassium Potassium is the major cation in the intracellular fluid and functions as the primary buffer within the cell itself Ninety percent of potassium 1s concentrated within the cell and damaged cells release potassium into the blood Potassium plays an important role in nerve conduction muscle function and helps maintain acid base balance and osmotic pressure Elevated potassium levels hyperkalemia can be found in oliguria anemia urinary obstruction renal failure due to nephritis or shock metabolic or respiratory acidosis renal tubular acidosis with the K H exchange and hemolysis of the blood Low potassium levels hypokalemia can be found in exces sive loss of potassium through diarrhea or vomiting inadequate intake of potassium malabsorption severe burns and increased secretion of aldosterone High or low potassium levels may cause changes in muscle irritability respiration and myocardial function The potassium value obtained may be used to monitor electrolyte imbalance in the diagnosis and treatment of infusion therapies shock heart or circulatory insufficiency acid base imbalance therapy with diuretics all kinds of kidney problems diarrhea and hyper and hypo function of adrenal cortex
58. g measurements How ever urine samples diluted with urine diluent are analyzed in the urine mode To access this mode press NO until QC STD DIALYSATE URINE SAMPLE appears on the display Press YES and then NO until Urine Sample appears Press YES and follow the prompts Upon completion of analysis the analyzer will calculate the final test results which will be displayed and printed See illustration 5 4 Note Ca and Li are not measured in urine Note If the result of the urine sample is given with TTTT the K value of the sample is higher than 45 mmol L and outside the measurement range of the analyzer The measurement must be repeated using the following procedure 1 Record the value of Na and CI if activated of the first urine measurement 2 Redilute the diluted urine already diluted 1 2 with urine diluent with distilled water in the ratio of 1 2 e g 1 mL of diluted urine and 2 mL distilled water Thoroughly mix the sample 4 Runa second urine measurement with the twice diluted urine sample 5 Ignore the Nat value and CI if activated 6 Multiply the K value by 3 and record U Chapter 6 Maintenance and Operator Functions Scheduled Maintenance Performing daily maintenance Prior to running your first sample of the day the AVL Electrolyte Analyzer needs to undergo a simple cleaning and conditioning procedure that helps ensure the unit will perform properly This procedure
59. he measuring chamber See illustration 6 7 Close the clamp on the left electrode holder by lifting it upward until it locks in the back position Ensure the electrodes are seated properly See illustration 6 8 Plug the tubing of the reference electrode into the receptacle below the left side of the measuring chamber See illustration 6 9 6 10 Installing measuring chamber TE A 0 M 6 12 Pump winding plate Slide the measuring chamber back until it snaps into position and close the front cover of the analyzer See illustration 6 10 At this time you may perform daily maintenance by pressing YES If daily maintenance is not needed press NO until CALIBRATION is displayed Press YES and a complete calibration cycle will be per formed Performing 6 month maintenance Every six months the peristaltic pump tubing needs to be replaced Note To make sure that the pump does not turn on during this procedure press NO until DAILY MAINTENANCE is displayed Press YES and Perform Daily Cleaning will appear Then do not press any keys To change the tubing open the analyzer front cover and slip the two pump windings from the analyzer pump rollers See illustration 6 11 Next disconnect one tube at a time from the old pump winding plate and reconnect to the same place on the new pump winding plate See illustration 6 12 63
60. hium has a very narrow therapeutic range Initial dosing 1s aimed at between 0 80 to 1 20 mmol L and the long term maintenance level 1s 0 60 to 0 80 mmol L The concentration of lithium in serum during therapy 1s closely monitored because lithium 1s acutely toxic with concentrations that are slightly higher than the above therapeutic range Urine Electrolytes The electrolytes present in the human body and also ingested daily from food are excreted from the body in a natural circulation via the renal system into the urine Measurement of electrolytes in excreted urine gives important information about the efficiency of the kidneys and other pathological situations Urine examinations can be made on a random urine sample or for a quantitative determina tion on a 24 hour collected urine sample The quantity of electrolytes excreted per day can be deter mined by multiplying the measured concentration mmol L with the total quantity of urine excreted in one day 3 Burritt MF Pierides AM Offord KP Comparative studies of total and ionized serum calcium values in normal subjects and in patients with renal disorders Mayo Clinic Proc 55 606 1980 VII Dialysate Electrolytes In the dialyzer arterial blood and suitable dialysate liquids are led to a dialysis membrane in opposite directions The structure of the membrane is such that it prevents the diffusion of proteins and red blood cells through the membrane Since the composition of th
61. ide ionized calcium and lithium are determined from the measurement of two of each respective unit configuration All values are reported in mmol L Material ISE trol Protein Based Aqueous Control Material Level 1 Parameter mean ow CV odd CV ST CV Sodium 114 6 0 48 0 42 0 76 0 66 0 89 0 78 Potassium 2 82 0 025 0 87 0 035 1 24 0 041 1 44 Chloride 76 7 0 29 0 38 0 52 0 67 0 72 0 94 ionized Calcium 2 07 0 015 0 72 0 024 1 18 0 034 1 66 Lithium 0 40 0 010 2 40 0 018 457 0 026 6 41 Material ISE trol Protein Based Aqueous Control Material Level 2 Parameter mean ow CV odd CV ST CV Sodium 141 2 0 40 0 28 0 30 0 21 0 46 0 33 Potassium 4 35 0 024 0 55 0 023 0 53 0 036 0 82 Chloride 102 4 0 18 0 18 0 20 0 20 0 32 0 31 ionized Calcium 1 35 0 016 1 21 0 021 1 55 0 042 3 10 Lithium 1 04 0 012 1 19 0 035 3 36 0 045 431 xviii Material ISE trol Protein Based Aqueous Control Material Level 3 Parameter Sodium Potassium Chloride ionized Calcium Lithium Material RNA EQUIL Reduced Bovine Hemoglobin Solution Level 2 mean Parameter Sodium Potassium Chloride ionized Calcium Lithium mean 158 8 5 74 1232 0 63 2 59 134 8 4 89 100 4 1 10 N A owr CV 0 51 0 32 0 027 0 48 0 36 0 29 0 010 1 52 0 025 0 97 Sw CV 0 53 0 40 0 039 0 79 0 43 0 43 0 008 0 75 Material Aqueous Standard Solution Level 1 Parameter Sodium Potassium Chloride ionized
62. ing electrode pin Ac y 8 6 Calcium electrode construction 105 Lithium Electrode Specifications The Lithium Electrode is a membrane electrode used for in vitro diagnostic measurement of lithium ions present in fluid samples It is designated with a Li marking on the top surface of the housing Construction Electrode housing transparent acrylic plastic Measuring membrane lithiumion selective Electrolyte chamber airtight filled with electrolyte solution for Li electrodes Pin connector silver silver chloride Ag AgCl Use and Care AVL Lithium Electrodes are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the electrode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode since these will attack the plastic housing Store the electrode in a clean dry place only after the electrode has been cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seal should be installed 1n the electrode during storage O ion selective ON membrane O ring seal electrolyte chamber measuring capillary serial number Inner connecting electrode pin Mo J 8 7 Lithium electrode construction 106 Reference Electrode Assembly Specifications The Reference Electrode Assembly is a device used as an electrical junction between the sample and electrical ground Cons
63. is called daily maintenance because it must be per formed once each day the analyzer is used to conduct sampling Note In case cleaning and or conditioning has not been performed within the last 24 hours the analyzer will automatically print on each sample report Perform Daily Maintenance The process involves cleaning and conditioning the sampling path including the probe and electrodes You will need to have ready the bottles of Cleaning Solution A and Electrolyte Conditioning Solution and a package of lint free tissues to use in drying the sample probe Check the bottles to ensure that the expiration date has not been reached Note If fewer than 5 samples are analyzed each day cleaning should be performed once a week instead of daily see weekly maintenance 9 s 6 1 Introducing Cleaning Solution A a xe 6 2 Cleaning probe 58 To begin daily maintenance press NO until the prompt DAILY MAINTENANCE is displayed Press YES to accept Perform Cleaning will be displayed Press YES to start the cleaning procedure The prompt Open Sample Door Introduce Sample will appear At this time pour a small amount of AVL Cleaning Solution A into a clean container Lift the sample door and the pump will begin to aspirate Introduce the cleaning solution to the sample probe See illustration 6 1 Continue holding the solution under the sample probe until the prompt Wipe Probe an
64. ition 6 6 Unclamping left electrode holder Slide the measuring chamber forward until it locks in the front position See illustration 6 5 Unclamp the left electrode holder by moving the clamp forward See illustration 6 6 Remove the reference electrode assembly from the analyzer Unscrew the reference electrode from the reference housing Store the reference electrode in the red transport housing filled with reference solution that has been poured from the electrode housing Note It is important that reference electrode always be stored in reference solution and never allowed to become dry Pour some bleach into a small container and sub merge the reference housing into the bleach ensuring that no air bubbles remain in the housing Note The reference connector and tubing do not need to be submerged After a period of 15 minutes remove the reference housing from the bleach thoroughly rinse the housing with tap water and dry Unscrew the red transport housing from the reference electrode and check that the o ring on the electrode is properly seated Save the transport housing 61 6 9 Installing ref electrode connector 62 Carefully screw the reference electrode into the reference electrode housing and place the assembly into the left side of the measuring chamber Note that the reference electrode has a lip on the bottom that rests on the flat edge of t
65. its Possible remedies e Ensure that electrodes are properly plugged in e Check for proper operation of the reference electrode assembly If necessary clean the reference electrode housing or replace the reference electrode e Perform daily maintenance e Replace the ISE SnapPak 83 84 NA NOT CAL D K NOT CAL D CL NOT CAL D CA NOT CAL D LI NOT CAL D These messages will be displayed in the event a specific electrode does not pass calibration There are several possible reasons for an electrode not to pass calibration Either a stable reading of Standard A could not be obtained within 6 aspirations of Standard A or the slope A B or A C is outside the limits Possible remedies e Perform daily maintenance Ensure that the electrode is properly plugged in e Check for leaks blockages bubbles or improper flow of calibration reagents e Clean or replace the electrode e Check and or replace the ISE SnapPak CLOG CHECK FLUID PATH If the unit is unable to clear the sample path or to aspirate any of the 3 Standards at the beginning of a calibration the message CLOG CHECK FLUID PATH will be displayed Please note that a defective reference housing may cause this message increased discharge of KCl Possible remedies e Make sure that the electrode o rings are present and seated properly Make sure there are no leaks in the fluid path e Check for a clog or crystallization in the fluid path
66. k position N EN A 6 26 Shutdown plug and electrodes removed J Tl N P jj gt gt e S 4 ll Ys IC X i 6 ui L d S e a A 6 27 Installing red relief clamps Unscrew the transport housing from the reference housing Empty the reference housing and place all electrodes 1n their protective boxes Remove the line with the red mark from its container Now the shut down plug can be removed Press YES See illustration 6 26 The display will prompt All 5 Relief Clamps In serted Install the red relief clamps making sure that they are snapped securely into position Press YES See illustration 6 27 Note Never insert the solenoid relief clamps with the ISE SnapPak in place The prompt Pump Windings Relieved appears First grasp the front winding close to the pump roller and gently pull it off the roller Repeat the same procedure for the rear pump winding Press YES The analyzer will ask Do You Wish to DELETE All Data If you press YES all QC values and statistics will be deleted and the sample number is reset to 0 QC and normal ranges as well as correlation factors printer settings date time and ISE SnapPak volume are reset to default Also all service codes are deacti vated A deletion of all data is recommended in case the analyzer is operated by different personnel later On 3 6 29 Paper feed button 74
67. ld be analyzed as soon as possible within one hour after collecting the sample If a brief storage is required do not cool the sample as the erythrocytes could burst and release the intracellu lar potassium creating an inaccurate value of potassium in the sample Plasma samples Collect the blood in a green top tube preferably with lithium or sodium heparin anticoagulant Note Lithium heparin may be used if lithium is not installed Centrifuge the sample and separate plasma into a different test tube or sample cup as soon as possible Plasma can be stored longer than whole blood samples If storage is required plasma samples should be capped and placed in the refrigerator Prior to analysis always allow sample to warm to room tem perature Note For whole blood and plasma samples the proper amount of anticoagulant must be used to prevent the sample from clotting DO NOT use anticoagulants such as EDTA citrate oxalate etc Serum samples Collect the blood in a red top tube containing no anticoagulant Allow the blood to clot and then centrifuge Separate the serum into a different test tube or sample cup as soon as possible Serum can be stored longer than whole blood though preferably capped and placed in the refrigerator Prior to measurement always bring the sample to room temperature Aqueous Samples Aqueous samples such as Standard A have to be measured in the Standard Mode Note The Standard Mode
68. lt is then calculated using a default temperature of 25 C Possible remedies e Check for proper sample preparation see Chapter 5 e Ensure the sample sensor cable is securely plugged in e Make sure room temperature is within specified limits 15 C to 32 C 60 F to 90 F e Perform Test Amplifier Service Functions to measure the actual temperature With the front door opened the temperature dis played should be approx 5 C above the actual room temperature 87 88 Service Functions To aid in testing and troubleshooting your AVL Electrolyte Analyzer there are various built in functions that you can access to evaluate the performance of the instrument From the READY display press NO until the prompt SERVICE FUNCTIONS appears Press YES Testing the electrodes You can test the voltage levels of the electrodes by using standard solutions or an external sample Press NO until the prompt Test Electrodes is displayed Press YES and the prompt Test Standard A will be displayed Press YES and the voltages for each electrolyte will appear Record these values Press NO to exit The prompt Test Standard B will now be displayed Press YES and the voltages for each electrolyte will appear Record these values Press NO to exit The prompt Test Standard C will now be displayed Press YES and the voltages for each electrolyte will appear Record these values and compare in this manner Electrode Standard A Standard
69. m to your specific requirements press NO You may now adjust the high and low values by using the NO key to change the number the YES key to accept the number 33 34 Programming correlation factors Correlation factors allow you to correlate results from your AVL Electrolyte Analyzer to other electrolyte analyzers Activated correlation values are taken into consideration when sampling whole blood serum plasma and QC samples They are not used for standard samples analyzed in the QC STD DIALYSATE URINE SAMPLE mode A separate set of correlation factors 1s available for dialy sate and urine samples Note In case the OC samples were switched to report direct ISE values Code OCC see Service Codes the values are NOT affected by correlation factors Note The measurement range as well as normal and OC ranges are ALWAYS checked against the DISPLAYED values Therefore you may have to adjust the OC and normal ranges to your correlation factors The correlation factors can be changed through the pro gramming menu Follow the steps at the beginning of this chapter that explain the PROGRAM INSTRUMENT display and enter the password Press NO until Program Corr Factors is displayed Press YES and the analyzer will prompt Reset Corr Factors Default Pressing YES to this prompt will cancel all correlation factors programmed and will return to the default values The analyzer will then advance to the printer programming f
70. monium bifluoride 100 mmol L none Temperature 5 30 C 41 86 F Expiration Date amp Lot Number are printed on each container label Urine Diluent BP0344 Use Contents Active Ingredients Additives Storage Stability PRECAUTIONS For use as a diluent for the measurement of urine samples in AVL electro lyte system Each bottle contains 500 mL of solution Sodium chloride 120 mmol L germicides Temperature 5 30 C 41 86 F Expiration Date amp Lot Number are printed on each container label Use of calibration solutions or electrodes not manufactured for AVL could void the warranty A waste container is provided with the ISE SnapPak which when used holds human body fluids which may be potentially infectious handle with appropriate care to avoid skin contact or ingestion FOR IN VITRO DIAGNOSTIC USE Procedure Materials Needed Description ISE SnapPak Cleaning Solution A Conditioning Solution Urine Diluent Printer Paper 5 rolls Part Number BP5186 BP1025 BP0380 BP0344 HP5025 xiii The AVL 9180 Analyzer allows the operator to select one of the following measuring modes whole blood serum urine standard Q C material acetate or bicarbonate depending on the sample type to be analyzed The analyzer automatically processes the sample through the necessary steps then prints and displays the results In the blood serum and Q C measuring modes the results for sodium
71. n the default analyzer setting the dialysate mode provides measurements identical to those performed in the standard mode Separate correlation factors for bicarbonate and acetate permit optimization of abso lute measurement which may be necessary for certain dialysate compositions see Chapter 3 Correlation Factors To access the dialysate mode press NO until QC STD DIALYSATE URINE SAMPLE appears Press YES then NO until Bicarbonate Sample or Acetate Sample appears Note If lithium is selected the dialysate mode is not available Due to interfering substances inherent in some dialy sate solutions you may need to establish correlation factors to obtain correct results 53 AVL 9180 ELECTROLYTE ISE NA K CL 25MAR96 16 55 Sample URINE Sample No 1 Na K Cl 263 mmol L 18 3 mmol L 118 mmol L 9 4 Urine sample report no additional dilution required a m AVL9180 ELECTROLYTE ISE NA K CL 02MAR96 10 07 Sample URINE Sample No 5 Na 142 mmol L K TTTT mmol L 5 5 Urine sample report additional 94 dilution required Urine samples Before measuring urine accurately dilute the sample with AVL Urine Diluent BP0344 in the ratio of 1 part urine to 2 parts diluent e g 1 mL urine and 2 mL urine diluent Thoroughly mix the sample and analyze in the urine mode Whenever READY appears on the display the unit is prepared to conduct samplin
72. nd the serum should be separated from the cells as soon as possible after collection The lithium electrode response is dependent on the actual sodium concentration of the sample The AVL 9180 Analyzer reports lithium in the range of 105 180 mmol L Na Interferences Salicylate in extremely high levels is known to interfere with the chloride electrode and results in a positive bias of the chloride result At therapeutic levels of salicylate concentration the influence on chloride is clinically insignificant The lithium electrode shows a slight sensitivity to the ionized calcium present in the sample and results in a negative bias of the lithium result At normal physiological ionized calcium concentra tions the influence of ionized calcium is clinically insignificant Kost GJ Arch Path Lab Med Vol 117 Sep 1993 p 890 95 XVI Relationship of ionized Calcium to total Calcium The ratio of ionized calcium to total calcium in a healthy population is around 0 50 or 50 These relationships may be altered when using citrate in blood or when the acid base metabolism is dis turbed Specific Performance Characteristics Reproducibility Typical Within Run Swr Between Day Saa and Total ST Precision is determined from 2 runs per day with 2 replicates per run for 20 days on two AVL 9180 analyzers in each of its three configura tions Values for sodium and potassium are average of all six instruments while values for chlor
73. ne pathogens Proper blood collection technique must be followed n order to minimize risk to the laboratory staff Gloves should always be worn when handling blood and other body fluids Please refer to NCCLS document M29 T2 Protection of Laboratory Workers from Infectious Disease Transmitted by Blood Body Fluids and Tissue Second Edition Tentative Guideline for further information on safe handling of these specimens Sample Requirements Refer to NCCLS document H11 A2 Percutaneous Collection of Arterial Blood for Laboratory Analysis Second Edition Approved Standard May 1992 for detailed information on sample collection storage and handling Blood sampling for analysis must be performed under proper supervision with details of collection including sampling devices site selection sample handling and documentation approved by the personnel responsible Specific procedures used should follow NCCLS guidelines Anticoagulants and Sample Collection Devices The AVL 9180 Electrolyte Analyzer will accept samples directly from syringes collection tubes samples cups and with the use of an adapter from capillary tubes or the AVL Microsampler For whole blood and plasma samples a balanced heparin that does not affect the electrolyte values is the recommended anticoagulant of choice Sodium heparin is also an acceptable anticoagulant for electrolyte analysis however heparin binds ionized calcium to a certain extent falsely decreasing
74. nel Display Control Panel Keypad W AN N Eq p N Sample Probe Mechanism ISE SnapPak NW T E 1 1 9180 Electrolyte Analyzer Major Components external 5 Front Door 1 J o Sa J 1 2 Control panel keypad N mne READY e 1 3 Control panel display Analyzer components The AVL Electrolyte Analyzer is a fully automatic microprocessor controlled medical instrument that measures Na Sodium K Potassium plus one of the following CI Chloride Ca Calcium Li Lithium The analyzer consists of several major components that are important for you to know and understand while becoming familiar with the unit See Illustration 1 1 You communicate with the analyzer through a keypad with YES and NO keys With these keys you can perform all analyzer functions including sample measurement data input programming and quality control testing See Illustration 1 2 The analyzer communicates to you through a dot matrix display This two line alpha numeric read out allows up to 16 characters per line displaying the activities of the analyzer sample results and other programmed information See Illustration 1 3 Measuring Chamber Thermal Printer AA OO Fluid Control Valves 1 4 9180 Electrolyte Analyzer Major Components internal 1 7 Peristaltic pump Inside the u
75. nit are other components which are accessible by opening the main door See illustration 1 4 and 1 5 The measuring chamber consists of the movable left locking device that holds the electrodes n place the electrodes the right electrode holder with sample sensor connector and the measuring chamber base Electrodes are labeled Ref Reference Na Sodium K Potassium CI Chloride Ca Calcium Lit Lithium See illustration 1 6 A peristaltic pump is used to transport all liquids within the analyzer See illustration 1 7 in m YE NI Om al i Hl di e 1 10 ISE SnapPak 8 Valves control the movement of the liquid within the analyzer See illustration 1 8 The sample probe mechanism is located behind the small door at the front of the unit See illustration 1 9 The self contained ISE SnapPak uses an integral check valve to ensure that waste cannot spill out of the package See illustration 1 10 AAA BE LMG N EITEFTE POWER REQUIREMENTS Tib 240 50 B0Hz 14A Mew MODEL 9180 SERIAL NU i FTU oan s a TOV gs CE Gn LR TD G PINa etw py rro 1 13 Rear panel The thermal printer uses heat sensitive paper to output information in 16 columns The analyzer will print measured values calibration values electrode voltages and amount of liquid remaining in the ISE SnapPak
76. nnnnnnonnnnnnncncnininonos 47 Chapter 6 Maintenance ooooooooooooooooooooononononnnnnnnnnnnnnnnnnnononnnnnnnncninin s 55 Chapter 7 Troubleshooting and Service Functions 75 Chapter 8 Principles of Operation 95 Chapter 9 Supplies Service and Warranty Registration 109 Appendix A Technical Specifications 114 Appendix B Program Flow Chart 116 Appendix C Maintenance Log Master 117 Appendix D Correlation Factor Worksheet Master 118 XXVII XXVIII Chapter 1 Getting to Know Your AVL Electrolyte Analyzer Important safety instructions Before you begin installing your AVL Electrolyte Ana lyzer carefully read the overview information in this chapter For your own safety and the proper operation of your equipment always follow these precautions when working with your AVL Electrolyte Analyzer e Keep the analyzer away from all sources of liquids such as sinks and wash basins e Don t use ammonia based or alcohol based cleaners which can chemically react with plastic on or around the analyzer e Always handle blood samples and collection devices with care e Use approved protective gloves to avoid direct contact with sample e Aseptic procedures are required when cleaning the sampling probe to avoid contamination e Dispose of ISE SnapPak according to local regu lations Control Pa
77. o repeat level 1 by pressing YES and repeating the sampling procedure or to skip to level 2 by pressing NO Note In case the value is outside the measurement range TTTT or ERR it will automatically be rejected If the values have been saved the analyzer will display VALUES ACCEPTED followed by the prompt QC Level 2 Sample To continue with QC mea surement press YES and follow the instructions as outlined for QC Level 1 Sample being sure to use a Level 2 ISE trol After storing values for QC Level 2 the analyzer will display VALUES ACCEPTED followed by the prompt QC Level 3 Sample To continue with QC measurement press YES and follow the instruc tions as outlined for QC Level 1 Sample being sure to use a Level 3 ISE trol Note If you wish to discontinue OC testing press NO until READY is displayed 45 46 At the completion of QC Level 3 testing the analyzer will prompt Remain in QC Std Urine Sample If all level testing has been completed press NO and the analyzer will return to READY Note Responding YES to the Remain in QC Std Urine Sample prompt will return the analyzer to the QC Level 1 Sample display Printing a QC report The analyzer will store in memory the last 35 mea surement values for each of the three levels of control To print a report of these values along with their mean standard deviation 1SD and coefficient of variation CV press the NO key until PRINT FUNCTIONS is
78. on 8 9 107 Use and Care AVL Reference Electrodes are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the Reference Elec trode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode Store the Reference Electrode in the transport housing provided with the electrode at the time of purchase Make sure that the transport housing 1s filled with reference electrolyte solution you may use the reference electro lyte solution remaining in the Reference Electrode Housing at the time of disassembly Note Never rinse the Reference Electrode with distilled water Never allow the Reference Electrode to become dry M cable housing platinum wire glass tube mercury Hg cotton wool calomel Hg Cl 8 8 Reference electrode housing 108 E 6 9 Reference electrode Chapter 9 Supplies Each AVL Electrolyte Analyzer is shipped with an initial supply of calibrating and operating solutions ISE trol Electrolyte Control accessories and mainte nance supplies Below is a listing of all necessary supplies and acces sories which you may need to replace during the use of your analyzer To order replacement supplies and accessories contact your local Authorized AVL Distributor or in the U S call AVL s Order Entry Department at 1 800 421 4646 Monday through Friday 8 AM to 5
79. ood in an untreated blood collecting tube The sample should stand for 30 minutes to allow the clot to form prior to centrifugation After centrifuga tion remove the serum from the clot and cap or seal the sample tube If storage 1s required the sample should be stored tightly capped under refrigeration at 4 to 8 C and allowed to return to room temperature 15 to 30 C prior to analysis Each laboratory should determine the acceptability of its own blood collection syringes capillaries and tubes and the serum or plasma separation products Variations in these products exist between manufacturers and at times from lot to lot Reagents ISE SnapPak BP5186 containing the following reagents Standard A Use For calibration of sodium potassium chloride 1onized calcium and lithium in the AVL 9180 Electrolyte Analyzer Contents 350 mL Active Ingredients Na 150 mmol L K 5 0 mmol L Cl 115 mmol L Ca 0 9 mmol L Lr 0 3 mmol L Additives Germicides Storage Temperature 5 30 C 41 86 F Stability Expiration Date amp Lot Number are printed on each container label Standard B Use For calibration of sodium potassium chloride 1onized calcium and lithium in the AVL 9180 Electrolyte Analyzer Contents 85 mL Active Ingredients Na 100 mmol L K 1 8 mmol L Cl 72 mmol L Ca 1 5 mmol L Lr 0 3 mmol L Additives Germicides Storage Temperature 5 30 C 41 86 F Stability Expiration Date amp Lot Number
80. ould now be displayed 4 Follow the same procedure to enter the correct time 19 M 2 18 Inserting printer paper 20 5 After entering the time the analyzer will prompt OK Press YES if the date and time you entered is correct or press NO to make a change 6 After entering YES the following prompt appears in the display STATUS NO SnapPak Install the ISE SnapPak M Record the installation date on the label on the pack Remove the protective strip and slide the ISE SnapPak into position on the left side of the analyzer See illustration 2 16 and 2 17 Note Once the protective strip is removed be sure to keep the SE SnapPak upright to avoid spillage Save the protective strip to use to close the nipples on the pack prior to disposing At the prompt New SnapPak Installed press YES Press YES again to the question Are you sure Install the thermal printer paper into the printer by placing the printer paper into the paper tray and threading it into the feeder slot as shown in the diagram underneath the paper holder on the analyzer See illustration 2 18 2 19 Paper advance button Press the paper advance button to bring the paper completely through the feeder See illustration 2 19 Note By pressing and releasing the paper advance button the paper will automatically advance 10 lines Your AVL Electrolyte Analyzer is now prepared for ini
81. plied with the analyzer Note Never attempt to turn the power off for an extended period of time without performing a com plete shutdown of the analyzer Note In case the analyzer is not being used for several days only it is not recommended to perform a complete shutdown but to put the analyzer in Standby Mode To perform the shutdown you will need the following items 6 22 Shutdown plug and containers installed Two containers one filled with at least 100 mL of water the other one empty Five solenoid relief clamps supplied with analyzer and shutdown kit Two reference electrode transport housings supplied with shutdown kit e One shutdown plug supplied with shutdown kit e Protective strip for ISE SnapPak supplied with shutdown kit To get started go to OPERATOR FUNCTIONS Press YES then NO until Take Out of Operation appears Press YES Next the analyzer prompts Shutdown Plug and Water Installed First remove the ISE SnapPak and push the protective strip firmly onto the fluid pack connector Insert the shutdown plug carefully into the fluid pack receptacle Next place the blue marked line into the disposable container filled with water The line with the red mark 1s inserted into the empty container Press YES See illustration 6 22 The analyzer will prompt Transport Ref Housing Installed Pull the electrode holder forward and remove the reference electrode assembly Ca
82. ps that should help you return your AVL Electrolyte Analyzer to operation This chapter includes two sections troubleshooting and service functions If your AVL Electrolyte Analyzer does not perform correctly after conducting the basic steps outlined in this chapter you should contact AVL for technical assistance i 8 Troubleshooting STATUS NOT CALIBRATED This message will be displayed when calibration has been interrupted Possible remedies e Perform system calibration to return the instru ment to the READY mode STANDARD A NOT DETECTED As the analyzer aspirates a sample of Standard A the solution is detected by the sample sensor which must detect its presence without encountering any air bubbles If the sample sensor is unable to properly detect the presence of Standard A solution in a programmed time period above error message will be displayed Possible remedies e Check the fluid remaining in the ISE SnapPak If less than 5 remains replace the ISE SnapPak e Check for clots or crystals that may have formed in the Standard A tubing or the electrode chamber e Replace the ISE SnapPak Ensure the sample sensor is securely plugged in and perform the sample sensor test to ensure that the sensor is operating correctly If necessary clean the sample sensor e Replace the peristaltic pump tube set to ensure correct aspiration of Standard A STANDARD B NOT DETECTED Detection of Standard B aspira
83. r 3 Programming Your AVL Electrolyte Analyzer comes preset to easily and accurately perform sampling operations Through the programming menu you have the capa bility to input additional information or parameters to tailor the instrument s performance to match the particular needs of your lab Programming the analyzer allows you to select the third testing channel and to modify quality control ranges normal values and correlation factors You can also program the operation of the printer Note For safety and security the analyzer can only be programmed or have existing parameters changed by entering the correct password via the control panel keypad Accessing programming functions From the READY display press NO until the prompt PROGRAM INSTRUMENT is displayed Press YES 2 28 The analyzer will display Enter Code AAA To program your AVL Electrolyte Analyzer you must now enter the code K E Y as follows 1 Press NO until the character K is displayed 2 Press YES and the cursor will advance to the second position 3 Press NO until E is displayed then press YES The cursor will advance to the last character 4 Press NO until Y is displayed Note If you pass the desired letter continue pressing NO until the letter is displayed again If you have entered the code correctly press YES The analyzer is prepared for operator programming and will display Program QC Level 1 Ranges Note If you inad
84. refully unscrew the reference electrode from the reference electrode housing Temporarily place the reference electrode on a clean soft cloth Next pour the remaining reference solution in the reference hous ing into a transport housing Then carefully screw the reference electrode into the filled transport housing 1 ES 6 25 Blue line removed for purge cycle 12 Now the second transport housing 1s screwed into the reference housing Place the reference housing back into the electrode holder and move the lever backwards making sure all electrodes are seated properly The electrode holder remains in the forward position Press YES See illustration 6 23 and 6 24 The analyzer will take approximately one minute to flush all lines with water Upon completion you will receive the prompt Remove Water and Press Yes Remove the line with the blue mark from the water and place it on a cloth making sure it 1s not obstructed The line with the red mark remains in its container Press YES During this cycle all lines are purged of water Upon completion the prompt All Electrodes amp Plug Removed will appear See illustration 6 25 Unplug the reference connector below the left side of the electrode holder Then move the lever on the left side forward and remove all electrodes placing them on a soft cloth Next move the lever back and push the empty electrode holder into its bac
85. relation factors available for Ca and Li since these param eters are not measured in urine mode 39 ES i y axis mmo 1 L N gt C 9 gt gt D gt x reference analyzer x axis u 3 1 Regression diagram 36 Calculating correlation factors If the analyzer you wish to correlate with does not compare to flame photometer values you may need to determine correlation factors This may be done using one of the following two methods a Correlation Factor Worksheet 1 Measure the AVL ISE trol level 1 and level 3 three times each on the AVL Electrolyte Analyzer and the reference analyzer The three measured values for each device should not differ by more than 2 0 mml L for Na 0 2 mmol L for K and 2 0 mmol L for CT 0 04 mmol L for Ca and 0 04 mmol L for Li 2 Fill out a Correlation Factor Worksheet for each parameter Follow the arrows and calculations to determine the intercept b and slope m See appendix for blank worksheets b Calculator with Regression Function 1 Analyze at least 20 lipid free serum samples or samples with normal lipids on the AVL Electrolyte Analyzer and on the reference analyzer Select samples with different concentrations in order to provide determination points from the lowest point to the highest point of the measurement range See illustration 3 1 2 Usea calculator with a linear regression func tion to determin
86. rent language setting remove the paper tray and use a pen to set the switch to the desired language position as indicated on the label Now locate the power switch on the back of the unit and make sure that it is in the OFF O position Next plug the power cord into the power receptacle module on the back of the unit then plug the cord into a grounded electrical outlet See illustration 2 14 Note If you decide to change the language after the unit is powered on you must cycle the power to activate the new language 2 15 Turning power on Push the power switch to the ON I position The unit will automatically begin to operate See illustration 2 15 Now that the AVL Electrolyte Analyzer is function ing you will begin using the keypad interface to communicate with the instrument Use the NO key to make changes the YES key to accept the displayed values or information The analyzer will display a default date and time and will allow you to input the correct date and time Date 01 JAN 80 Time 00 00 Enter the correct date as follows 1 Press the NO key until the correct day is displayed Press YES The cursor will move to the month Note By keeping the NO key depressed the analyzer will automatically scroll through the numbers first slowly then fast 2 Press NO until the correct month is displayed Press YES 3 Press NO until the correct year is displayed Press YES The correct date sh
87. rmation or press NO if you decide to keep the current lot number and data 29 30 Note If you enter YES all stored statistics for this OC level will automatically be deleted from memory To enter a new lot number press NO until the correct number is displayed above the cursor and YES to accept Repeat until all four digits have been entered After entering the new lot number the analyzer will ask you to confirm that the entry is correct To proceed with QC programming press YES Note If you have entered an incorrect lot number enter NO and you will return to the Enter Lot Number prompt The analyzer will now sequentially display high and low ranges for the electrolytes that correspond with the QC level and lot number such as 040 205 Na low Na high Note You may find this information printed on the data sheet contained inside the box of ISE trol Press YES and the next electrolyte range will be dis played After all activated parameters have been programmed the display prompts Additional Param eters Pressing YES will allow you to program the deactivated parameters as well After each range has been displayed QC Level 1 pro gramming will be completed The AVL Electrolyte Analyzer will prompt Program QC Level 2 Ranges To continue programming repeat the above proce dure for QC Level 2 and QC Level 3 At the completion of QC Level 3 programming the analyzer will prompt Program Normal Ranges This
88. rompt Leave Standby Mode will be displayed 2 Press YES Note If less than four hours have elapsed since the last calibration the analyzer will return to READY If more than four hours have elapsed the analyzer will exit to the daily maintenance menu If cleaning conditioning has not occurred in the past 24 hours perform the daily maintenance now If cleaning conditioning is not needed press NO to start cali bration Setting date and time The date and time of the AVL Electrolyte Analyzer can be easily changed as necessary To change the date and time enter the OPERATOR FUNC TIONS menu and press NO until Set Time Date is displayed Press YES to enter the time date setting menu The current time date is displayed with the ques tion OK Respond with NO if you want to change the time date Press YES to exit 3 Press NO until the correct day is displayed Press YES The cursor will move to the month 4 Press NO until the correct month is displayed Press YES 5 Press NO until the correct year is displayed Press YES The correct date should now be displayed 6 Follow the same procedure to enter the correct time The analyzer will prompt OK Press YES if the date and time you entered is correct or press NO to continue making changes D Changing Parameter Configuration Your analyzer s designed to allow easy change of parameter configuration To change the current parameter configuration enter the
89. s Proper care should be used in handling and storage of the electrode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode since these will attack the plastic housing Store the electrode in a clean dry place only after the electrode has been cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seal should be installed in the electrode during storage A ion selective membrane O ring seal electrolyte chamber measuring capillary l serial number electrode connecting pin M E 6 4 Potassium electrode construction 103 Chloride Electrode Specifications The Chloride Electrode is a membrane electrode used for in vitro diagnostic measurement of chloride ions present in fluid samples It is designated with a Cl marking on the top surface of the housing Construction Electrode housing transparent acrylic plastic Measuring membrane chloride ion selective Electrolyte chamber airtight filled with electrolyte solution for CT electrodes Pin connector silver silver chloride Ag AgCl Use and Care AVL Chloride Electrodes are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the electrode Never use strong or abrasive cleaners such as alcohol or amphyl on the electrode since these will attack the plastic housing Store the electrode in a clean dry place only after the ele
90. s and measuring chamber The next procedure involves preparing and installing the electrodes in the measuring chamber Remove the reference housing and electrodes from their protective boxes and place them on a soft clean surface Check that each electrode has an o ring in the left side of the electrode See illustration 2 4 15 2 5 Transport housing removal reference electrode reference electrode red transport housing S 2 6 Installing reference electrode A o Es 2 1 Slide chamber forward 16 Unscrew the red transport housing from the reference electrode and check that the o ring on the electrode is properly seated Save the transport housing for storage of the reference electrode in the event the analyzer 1s turned off or taken out of service for any reason See illustration 2 5 Carefully screw the reference electrode into the reference electrode housing and place it with the other electrodes See illustration 2 6 Slide the measuring chamber forward until it locks in the front position Unclamp the left electrode holder by moving the clamp forward See illustrations 2 7 and 2 8 S A 2 8 Unclamping electrode holder VA UE Nd d 2 10 Installing electrodes 2 11 Closing electrode clamp Locate the sample sensor cable and ensure that it 1s securely inserted into the receptacle
91. spirate Introduce the cleaning solution to the probe See illustration 2 20 Hold the solution under the probe until the prompt Wipe Probe Close Sample Door is displayed Use a lint free tissue to remove the cleaning solution from the probe then close the door See illustration 2 21 The analyzer will now display Thank You and a brief countdown will begin indicated by the clock in the lower right of the display While the countdown is running open the bottle of AVL Electrode Condition ing Solution and pour a small amount into a clean container After the countdown is completed the system will prompt Perform Daily Conditioning Press YES a 2 22 Introducing conditioner gue N a ie S A 2 23 Cleaning probe The prompt Open Sample Door Introduce Sample will be displayed Lift the sample door The prompt Introduce Sample will be displayed and the pump will begin to aspirate Now introduce the conditioning solution to the probe See illustration 2 22 Hold the solution under the probe until the prompt Wipe Probe Close Sample Door is displayed Use a lint free tissue to remove the conditioning solution from the probe and close the door See illustration 2 23 The analyzer will now display Thank You and a brief countdown will begin Upon completion of the countdown the prompt Remain in Daily Mainte nance will be displayed Press NO The unit will display Calibration in Process
92. t it is operating correctly Replace pump windings CLEANING FLUID NOT DETECTED Under certain conditions the analyzer may not detect the presence of cleaning solution This could be caused by air bubbles in the cleaning solution too small a volume of cleaning solution or the cleaning solution not being aspirated properly through the sampling mechanism Possible remedies Check for the presence of o rings and for proper sealing of the electrodes Check for aspiration of cleaning solution and look for presence of clots in the sampling system Check for the proper sealing of the pump windings Ensure that the sample sensor is plugged in and perform Test Sample Sensor to verify that it Is operating correctly 61 82 CONDITIONING FLUID NOT DETECTED Under certain conditions the analyzer may not detect the presence of conditioning solution This could be caused by air bubbles in the conditioning solution too small a volume of conditioning solution or the condi tioning solution not being aspirated properly through the sampling mechanism Possible remedies e Check for the presence of o rings and for proper sealing of the electrodes e Check for aspiration of conditioning solution and look for presence of clots in the sampling system e Check for the proper sealing of the pump windings Ensure that the sample sensor is plugged in and perform Test Sample Sensor to verify that it Is operating correctly INTERFA
93. ter CDC DEC This service code will increase the resolution by one digit for all parameters in blood and serum samples QC and standard samples are always shown in high resolution urine samples in low resolution ECO This service code will automatically put the instrument into Standby Mode if no samples are run between two calibrations 4 hrs This feature mainly helps to conserve reagents When the unit automatically enters the Standby Mode it 1s always necessary to perform a calibration to get back to the READY prompt FIF This service code will automatically print the voltage levels of the electrodes on sample and calibration re ports This code should only be used by trained service techni cians To disable this code either enter IFI or turn the power off and back on LEM This service code will print the last 20 error messages with the date and time of occurrence MEL will erase all error messages stored MGL Ca activated This service code allows you to report Ca values in mg dL instead of mmol L When this code is set the unit automatically converts the current high and low values of the normal ranges to mg dL Note that QC and standard measurements are always reported in mmol L indepen dent of the MGL setting This allows you to compare the Ca values to the ISE trol assay ranges NOB This service code disables the beep SLC When this code is set the current setting of the leasing co
94. th a refer ence electrode to form a measuring system When immersed in a solution that contains the relative ion the Nernst equation applies R T l BB Ina n F Or R T 2 ESEE In c for cations n F for anions The equation can also be written 3 B E ES log fc the measured electric potential the e m f of the system in a standard solution activity of the ion measured the general gas constant 8 31 J Kmol temperature valence of the measured ion Faraday constant 96 496 A s g equivalent the activity coefficient the concentration of the measured ion the slope of the electrode d5 3ue mtm no See illustration 8 2 99 100 If the ion concentration of one measuring solution is known the 10n concentration of the sample can be determined on the basis of the difference of two measured potentials i E ons E S i log f C ample 3 aed B E m S log f l C 1 sample 6 AE E ample y B onn S log C standard AE the difference between the measured potentials ofthe sample and the stan dard S the potential difference of the elec trode determined from the potential difference of two measured standard solutions concentration of the measured ions in the sample 1sample concentration of the measured ions in the standard solutions C standard The unknown ion concentration in the sample can now be determined by T Cc 1048 38 1 sample 1 standard
95. the sample to the probe See illustration 5 1 Note It is very important that the main door is closed during sampling since it provides shielding from sources of electromagnetic interference Hold the sample under the probe until Wipe Probe Close Sample Door is displayed Use a lint free tissue to clean the probe then close the sample door when prompted See illustration 5 2 Note Itis very important that the sample probe is carefully cleaned each time following a sample introduction The analyzer will display Thank You and a brief countdown will begin Upon completion of analysis the test results will be displayed and printed See illustration 5 3 Note Values that are higher or lower than the programmed normal range will be indicated by an arrow pointing up or down Note If the Na result is above 180 mmol L above 169 5 mmol L for blood serum or below 95 mmol L below 89 6 mmol L for blood serum the Li value cannot be derived If an additional sample report is desired or the auto matic sample report is turned off the results may be printed by following these steps 1 Press NO 2 The prompt PRINT FUNCTIONS will be displayed Press YES to accept Print Last Sample Report will be displayed Press YES to accept The test results will be displayed and the report will print 7 The analyzer will return to READY As d Dialysate samples Dialysate samples are measured in the dialysate mode I
96. tial daily maintenance Initial daily maintenance Prior to performing your first calibration or running your first sample the AVL Electrolyte Analyzer needs to undergo a simple cleaning and conditioning proce dure that helps ensure that the unit will perform properly This procedure is called daily maintenance because it must be performed each day the analyzer is used to conduct sampling The process involves cleaning and conditioning the sample path and electrodes which prepares the AVL analyzer for calibration You should have ready the bottles containing Cleaning Solution A and Electrolyte Conditioning Solution along with a package of lint free tissues that will be used to dry the probe Note Check expiration date on bottles Note In some cases when the unit prompts you for an action and you do not respond within a set period of time an alarm will sound and the unit will discon tinue its current operation 21 q P 2 20 Introducing cleaning solution a Nx P is 2 21 Cleaning probe 22 To perform daily cleaning you will communicate through the keypad interface The prompt Perform Daily Cleaning will be displayed Press YES to accept The prompt Open Sample Door Introduce Sample will be displayed Pour a small amount of AVL Cleaning Solution A into a clean sampling container Lift the sample door The prompt Introduce Sample will be displayed and the pump will begin to a
97. tion is the same as for Standard A If Standard A is aspirated properly but Standard B 1s not detected check Standard B tubing for crystallization Ifno crystallization or leaks are found replace the ISE SnapPak STANDARD C NOT DETECTED Li activated Detection of Standard C aspiration is the same as for Standard B See remedy for Standard B CHECK SAMPLE SENSOR The sample sensor is calibrated with air during each calibration For proper functioning the sensor must provide a reading of 80 120 units when air is de tected To check sample sensor response perform Test Sample Sensor Open the sample door and press the YES key to aspirate various fluids through the sensor For transparent fluids e g water the reading should increase by at least 40 units For blood samples not transparent the reading should decrease by atleast 40 units The pump can be stopped at any time by pressing NO After troubleshooting perform a calibration to remove the error message Possible remedies e Clean sample sensor by using the Daily Maintenance procedure e Check for correct drying of the measuring chamber during the wash cycle e Replace the peristaltic pump tube set 79 80 CHECK REFERENCE HOUSING When the analyzer fails to detect a flow of Reference Solution into the measuring chamber CHECK REF ERENCE HOUSING will be displayed This test is performed at the beginning of each calibration cycle Possible remedi
98. truction The Reference Electrode Assembly consists of two parts the Reference Electrode Housing and the Reference Electrode Reference Electrode Housing In the Reference Electrode Housing reference electrolyte solution estab lishes the electrical contact between the Reference Electrode and the sample At the beginning of each measurement reference electrolyte is pumped into the housing At the same time a glass capillary allows a small amount of reference electrolyte to pass into the measuring capillary thus establishing electrical contact between the sample and the Reference Electrode See illustration 8 8 Use and Care AVL Reference Electrode Housings are manufactured for use in AVL 9180 Electrolyte Analyzers Proper care should be used in handling and storage of the electrode housing Never use strong or abrasive cleaners such as alcohol or amphyl on the housing Store the Reference Electrode Housing in a clean dry place only after the Reference Electrode has been removed and the housing cleaned and rinsed with distilled water and dried with a lint free cloth The o ring seals should be installed in the housing during storage Reference Electrode The Reference Electrode completes the electrical circuit between the refer ence electrolyte and electrical ground This is accomplished by a cotton wool saturated with reference electrolyte calomel Hg Cl mercury Hg platinum wire connecting pin junction See illustrati
99. ule from the box of ISE trol and mix carefully Gently tap the head of the ampule with your fingernail to remove any liquid Carefully open the ampule by breaking off the top Note Protect your fingers by using gloves or tissue while breaking ampule Lift the sample door and the prompt Introduce Sample will be displayed Introduce the control to the sample probe See illustration 4 1 Note It is very important that the main door is closed during sampling since it provides shielding from sources of electromagnetic interference Hold the ampule under the probe until the prompt Wipe Probe Close Sample Door is displayed Use a lint free tissue to remove the control from the probe then close the door See illustration 4 2 Note It is very important that the sample probe is carefully cleaned each time following a sample introduction The instrument will display QC Level 1 in process and a countdown will begin during which the control will be analyzed Upon completion the results will briefly be displayed such as Na K JCI 125 1 3 05 77 8 Note The AVL Electrolyte Analyzer flags values that are above or below the programmed target ranges by using an up or down arrow The analyzer will automatically prompt Store Val ues in Memory To save the values in memory press YES To reject the values press NO Ifthe values are rejected the analyzer will return to the QC Level 1 Sample display allowing you t
100. unctions Press NO to the prompt Reset Corr Factors de fault and the analyzer will display Input Verify Corr Factors Pressing NO will allow you to exit the correla tion factor section and proceed to the printer programming functions Pressing YES to the prompt Input Verify Corr Factors will allow you to input your own correla tion factors or to verify or change correlation factors already programmed The current values will be displayed such as 00 0 1 000 ok Na b Na m If the Na intercept b and the slope m are correct press YES If you wish to change the values press NO You may now adjust the intercept and slope values by using the NO key to change the number the YES key to accept the number The programmed factors are automatically applied to blood serum and QC samples Follow the same procedure for the intercept b and slope m for K Cl Ca and Li Note Only activated parameters can be pro grammed If Na K Na K CT or Na K Ca are activated a separate set of bicarbonate and acetate correlation factors can be programmed Press YES to Program Bicarb Corr Factors and or Program Acetate Corr Factors Program these factors as described above The programmed factors are automatically applied to acetate and bicarbonate measurements A separate set of correlation factors 1s availabe for urine samples Press YES to Program Urine Corr Factors Note that there are no urine cor
101. unter which cannot be reset by the operator 1s printed on the calibration report 93 94 SFC This code allows the input of a percentage for the ISE SnapPak counter When this code is activated the analyzer displays SnapPak Counter xxx ok If this percentage is not correct press NO and enter the correct percentage between 0 and 100 using the NO and YES keys Pressing YES to ok will return the analyzer to the ready screen QCC When this code is enabled the QC measurements will be reported in direct ISE instead of flame equivalent values Note that no correlation factors are applied to the measurement values if QCC is set With the exception of FIF all service codes are permanently stored in memory and will be retained during power failures The service codes currently set can be printed on the calibration report Chapter 8 Principles of Operation The measurement principle Your AVL Electrolyte Analyzer is a sophisticated medical instrument that uses the Ion Selective Elec trode ISE measurement principle to precisely deter mine electrolyte values Although the technology itself is quite complicated understanding how the instrument performs sampling analysis 1s relatively simple Basically the analyzer compares an unknown value against a known value to compute the sample s electrolyte level An ion selective membrane undergoes a specific reaction with the type of electrolyte contained in the
102. vertently enter an incorrect code the analyzer will display CODE ERROR RETRY Enter YES and you will be returned to the Enter Code prompt To exit this menu press NO Programming QC Level ranges When you open a new box of AVL ISE trol Electro lyte Controls the lot number should be entered into the analyzer along with the target ranges Each level has its own lot number which is printed on the infor mational sheet contained inside the ISE trol box Note AVL ISE trol Electrolyte Controls are spe cially designed for your AVL Electrolyte Analyzer and should be used exclusively to ensure absolute quality and consistency of your patient samples To enter the lot number proceed from the display Program QC Level 1 Ranges Enter YES and the analyzer will prompt Current Lot 0000 Change Lot Note The first time OC lot number information is entered the AVL Electrolyte Analyzer will display a default lot number Thereafter the current lot num ber will appear Note If you do not desire to change current lot information but wish to verify current programmed OC ranges press NO Press YES and Print old Values and Statistics will be displayed Select YES to receive a printout that contains information including the mean standard deviation SD and coefficient of variation CV of stored data or press NO to decline The analyzer will display New Lot Delete Old Data Select YES to continue entering new lot number info

9180 Electrolyte Analyzer Operator`s Manual

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